单孔胸腔镜下Ⅰ期非小细胞肺癌根治术中模块化系统性淋巴结清扫的应用研究

贡会源; 杏福宝; 李晨; 李小军; 耿阳; 陈鹏飞

doi:10.16766/j.cnki.issn.1674-4152.003151

单孔胸腔镜下Ⅰ期非小细胞肺癌根治术中模块化系统性淋巴结清扫的应用研究

doi: 10.16766/j.cnki.issn.1674-4152.003151

贡会源^{1, 2},
杏福宝¹,
李晨¹,
李小军^1, ,,
耿阳¹,
陈鹏飞¹

1.
蚌埠医学院第一附属医院胸外科，安徽蚌埠 233004
2.
安徽省呼吸系统疾病(肿瘤)临床研究中心，安徽蚌埠 233004

基金项目:

安徽省中央引导地方科技发展基金项目 2020b07030008

安徽省高等学校自然科学研究项目 KJ2020A0575

详细信息

通讯作者:
李小军，E-mail: 492658765@qq.com

中图分类号: R734.2 R730.56
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出版历程
- 收稿日期: 2023-01-03
- 网络出版日期: 2023-10-19

Application of modular systematic lymph node dissection in uniportal thoracoscopic radical resection for stage Ⅰ non-small cell lung cancer

1.
Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探索在单孔胸腔镜非小细胞肺癌根治术中如何对系统性淋巴结清扫流程进行优化，并评估其临床应用效果及安全性。方法选取2020年10月—2022年10月期间在蚌埠医学院第一附属医院胸外科行单孔胸腔镜非小细胞肺癌根治术的100例患者为研究对象，将其按不同的淋巴结清扫方式分为研究组和对照组，每组各50例。研究组术中采用模块化流程进行系统性淋巴结清扫，对照组术中采用常规流程行系统性淋巴结清扫。评估指标包括纵隔淋巴结清扫数目、手术时间、术中出血量、术后引流量、胸引管留置时间及术后住院时间等，对比2种淋巴结清扫流程在单孔胸腔镜肺癌根治术中的应用效果。结果研究组纵隔淋巴结清扫数目[(7.6±0.9)个]明显优于对照组患者[(7.2±1.0)个]，差异有统计学意义(P < 0.05)。研究组的手术时间[(103.8±9.9)min]明显短于对照组[(121.4±9.3)min]，术中出血量[(77.5±9.2)mL]、术后引流量[(268.1±16.4)mL]、胸引管留置时间[(3.4±0.9)d]及术后住院时间[(4.0±1.0)d]均少于对照组[(84.9±11.8)mL、(304.9±18.3)mL、(4.8±1.1)d、(5.4±1.1)d]，差异有统计学意义(均P＜0.05)。结论在单孔胸腔镜非小细胞肺癌根治术中采用模块化流程行系统性淋巴结清扫，可以缩短手术时间，减少术后引流量及胸引管留置时间，有助于患者快速康复，安全性良好，值得临床推广应用。
- 淋巴结清扫 /
- 单孔胸腔镜 /
- Ⅰ期非小细胞肺癌
Abstract: Objective To optimize the process of systematic lymph node dissection in single-port video-assisted thoracoscopic radical resection of non-small cell lung cancer and evaluate the clinical application effect and safety. Methods From October 2020 to October 2022, 100 patients who underwent single-port thoracoscopic radical resection of non-small cell lung cancer at the Thoracic Surgery Department of the First Affiliated Hospital of Bengbu Medical College, were selected as the research subjects. They were then divided into study group and control group according to different ways of lymph node dissection, with 50 cases in each group. The study group used a modular approach to systematic lymph node dissection. In the control group, systematic lymph node dissection was performed routinely during the operation. Evaluation indicators included the number of dissected mediastinal lymph nodes, operation time, intraoperative blood loss, postoperative drainage volume, chest tube indwelling time and postoperative hospital stay. The application of two lymph node dissection techniques in single-port thoracoscopic radical resection of lung cancer was compared. Results The number of dissected mediastinal lymph nodes in the study group (7.6±0.9) was significantly better than that in the control group (7.2±1.0), and the difference was statistically significant (P < 0.05). The operation time of the study group [(103.8±9.9) min] was significantly shorter than that of the control group [(121.4±9.3) min], and the intraoperative blood loss [(77.5±9.2) mL], postoperative drainage volume [(268.1±16.4) mL], chest tube indwelling time [(3.4±0.9) d] and postoperative hospital stay[(4.0±1.0) d] were all less than those of the control group [(84.9±11.8) mL, (304.9±18.3) mL, (4.8±1.1) d, (5.4±1.1) d], and the differences were statistically significant (all P < 0.05). Conclusion In single-port thoracoscopic radical resection of non-small cell lung cancer, systematic lymph node dissection using modular procedures can shorten the operation time, reduce postoperative drainage volume and chest tube indwelling time, help patients recover quickly, and is worthy of clinical application with good safety.
- Lymphal node dissection /
- Uniportal video-assisted thoracoscopic surgery /
- StageⅠnon-small cell lung cancer

HTML全文

图 1 右侧上纵隔区域淋巴结清扫(下半部分)

注：AV为奇静脉；4R为右侧第4组淋巴结；RMB为右主支气管; RPA为右肺动脉；SVC为上腔静脉。

Figure 1. Right superior mediastinal lympha node dissection (the lower half part)

下载: 全尺寸图片幻灯片

图 2 右侧上纵隔区域淋巴结清扫(上半部分)

注：AV为奇静脉；SVC为上腔静脉；RMB为右主支气管; Tr为气管；2R为右侧第2组淋巴结；4R为右侧第4组淋巴结；PN为膈神经。

Figure 2. Right superior mediastinal lympha node dissection (the upper half part)

下载: 全尺寸图片幻灯片

图 3 右侧隆突下淋巴结清扫

注：7R为右侧第7组淋巴结；Eso为食管；LMB为左主支气管；RMB为右主支气管。

Figure 3. Right subcarinal lympha node dissection

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图 4 左侧上纵隔区域淋巴结清扫(前半部分)

注：5L、6L为左侧第5、6组淋巴结；PN为膈神经；Ao为主动脉；LPA为左肺动脉。

Figure 4. Left superior mediastinal lympha node dissection (the anterior half part)

下载: 全尺寸图片幻灯片

图 5 左侧上纵隔区域淋巴结清扫(后半部分)

注：Ao为主动脉；VN为迷走神经；4L为左侧第4组淋巴结；LPA为左肺动脉。

Figure 5. Left superior mediastinal lympha node dissection (the posterior half part)

下载: 全尺寸图片幻灯片

图 6 左侧隆突下淋巴结清扫

注：Ao为主动脉；RMB为右主支气管；LMB为左主支气管；Eso为食管；7L为左侧第7组淋巴结。

Figure 6. Left subcarinal lympha node dissection

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表 1 2组非小细胞肺癌患者手术指标比较(x ±s)

Table 1. Comparison of surgical indexes in 2 groups of patients with non-small cell lung cancer(x ±s)

组别	例数	手术时间 (min)	术中出血量 (mL)	纵隔淋巴结清扫数目(个)	术后引流量 (mL)	胸引管留置时间(d)	术后住院时间 (d)
对照组	50	121.4±9.3	84.9±11.8	7.2±1.0	304.9±18.3	4.8±1.1	5.4±1.1
研究组	50	103.8±9.9	77.5±9.2	7.6±0.9	268.1±16.4	3.4±0.9	4.0±1.0
t值		9.168	3.510	-2.448	10.593	7.281	6.370
P值		< 0.001	0.001	0.016	< 0.001	< 0.001	< 0.001

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