| Background and Obstract:For patients with stage IA non-small cell lung cancer(NSCLC),single-port thoracoscopy(uniportal video-assisted thoracic surgery,U-VATS)anatomical segmentectomy simultaneously removes the lung tumor,As much as possible to preserve the patient's lung function,is an acceptable alternative treatment for lobectomy.This article explores the safety and short-term efficacy of U-VATS anatomical segmentectomy for stage IA NSCLC,with a view to providing evidence-based evidence for future clinical treatment.Methods:The clinical and pathological data of IA NSCLC patients who underwent U-VATS segmentectomy at our hospital(the same medical group and the same surgeon)from September 2017 to June 2019 were collected and retrospectively studied.According to the inclusion and exclusion criteria,a total of 47 patients met the eligibility criteria,and these 47 patients were set as the observation group(pulmonary segment group).The 209 patients who underwent U-VATS lobectomy during the same period were set as the control group(lobe group).When comparing the clinical and pathological conditions of these two groups of patients,we found that the two groups were biased and significantly different in the two factors of age and tumor diameter(P <0.05).In order to reduce the bias,matching of propensity scores(PSM),using the nearest neighbor matching method,matching at 1: 1.In the end,42 patients in the U-VATS lung segment group and the lung lobe group were matched.Perioperative indicators,postoperative VAS(pain score)scores,FEV1% and FVC%,and QOL(quality of life)scores at 1 and 3 months after operation were analyzed.Results:All patients successfully completed the operation,there were no perioperative deaths,and no serious perioperative complications,such as cardiovascular and cerebrovascular accidents.84 patients were followed up for 4-20 months,with an average follow-up of 8.2 months.No tumor-related recurrence and death occurred.(1)Comparison of relevant clinical indicators of lung segment group vs.lung lobe group after surgery: Removal time of thoracic drainage tube in lung segment group [(4.76 ± 0.97)d vs.(5.31 ± 1.06)d,P = 0.017],total postoperative drainage [680.33 ± 75.47)ml vs.(722.14 ± 87.30)ml,P = 0.024],postoperative hospital stay [(5.45 ± 1.20)d vs.(6.02 ± 1.22)d,P = 0.036] is superior to the lung lobe group,with statistics There was a difference(P <0.05),but in terms of operation time [(165.10 ± 32.91)min vs.(150.76 ± 26.49)min,P = 0.031],it was longer than the lung lobe group,which was statistically different(P <0.05).The remaining clinical indicators There were no significant differences between the two groups.(2)Comparison of postoperative VAS scores in the lung segment group vs.In the lung group patients: the 24 h VAS score [(5.02 ± 0.81)points vs.(5.71 ± 0.86)points,P <0.001],48 h VAS score [(6.48 ± 0.95)points vs.(6.95 ± 1.07)points,P < 0.001],72 h VAS score [(3.14 ± 0.64)points vs.(3.79 ± 0.80)points,P <0.001],5th day VAS score [(1.86 ± 0.56)points vs.(2.43 ± 0.73)points,P <0.001],Are lower than the lung lobe group,with statistical difference(P <0.05).The pain in both groups of patients at 48 hours after surgery was more serious than at 24 hours after surgery,and reached a peak at 48 hours after surgery;the pain at 72 hours and 5 days after surgery was significantly improved compared to 24 hours and 48 hours.(3)Comparison of the incidence of postoperative complications in the lung segment group vs.the lung lobe group: The postoperative complication rate of the lung segment group was 31.0%,including(8 cases of pneumonia,4 cases of air leakage time> 3 days,2 cases of atelectasis,and 1 case of atrial fibrillation);the postoperative complication rate of the lung lobe group was 35.7 %,Including(7 cases of pneumonia,3 cases of air leakage time> 3 days,4 cases of atelectasis,2 cases of atrial fibrillation,1 case of empyema,1 case of hoarseness),the incidence of postoperative complications in both groups was not statistically significant Difference(P> 0.05).All patients' postoperative complications were cured through active drug treatment,nursing intervention,endoscopic treatment,nutritional support,etc.No serious adverse consequences occurred.(4)Comparison of FEV1% and FVC% in lung segment group vs.lung lobe group: FEV1% [(80.2 ± 7.4)% vs.(76.4 ± 9.9)%,P = 0.327],FVC% [(73.1 ± 8.3)% vs.(71.7 ± 9.6)%,P = 0.159],no statistical difference(P> 0.05).In the 3 month postoperative FEV1% and FVC% lung function indexes,FEV1% [(85.5 ± 10.6)% vs.(78.7 ± 8.1)%,P = 0.002],FVC% [(79.7 ± 10.1)% vs.(73.4 ± 9.2)%,P = 0.013],the lung segment group was significantly better than the lung lobe group(P <0.05),especially in the FEV1% difference.(5)Comparison of QOL scores of patients in lung segment group vs.lung lobe group: The preoperative QOL score [(31.12 ± 4.22)points vs.(32.52 ± 4.99)points,P = 0.173],no statistical difference(P> 0.05);the QOL score of the lung segment group after 1 month [(2.29 ± 5.78)Points vs.(39.60 ± 5.45)points,P = 0.033] is superior to the lung lobe group,and the QOL score [(48.02 ± 6.45)points vs.(43.71 ± 6.04)points,P = 0.002] in the lung segment group is significantly better In the lung lobe group(P <0.05).Conclusion:U-VATS segmentectomy is equivalent to lobectomy in the short term.Both surgical methods are safe and effective,but the postoperative pain of the lung segment is lighter,the postoperative quality of life is higher,and it is more effective in protecting lung function.The advantage is an alternative treatment that is more suitable for elderly patients with poor lung function. |
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