背景与目的全胸腔镜肺段切除术随早期肺癌的高检出率逐渐受到关注，其中肺段切除术段间平面分离最常用的方法是电刀切割手工缝合和应用直线切割缝合器机械切割两种。但仅有很少的研究对两者进行对比，且均针对开放式肺段切除术，目前尚未有相应的研究针对全胸腔镜肺段切除术。本研究旨在探讨两种方法在全胸腔镜手术中的应用及安全性对比。方法回顾性分析2013年9月-2016年3月北京大学第一医院胸外科行全胸腔镜肺段切除术的连续58例患者，根据段间平面分离方法不同分为电刀切割组30例和机械切割组28例，对两组患者手术时间、出血量、术后胸管留置时间、术后住院时间、胸腔引流量及术后并发症进行比较。结果除手术时间[电刀切割组（248.70±54.46）min和机械切割组（209.39±67.25）min]两组间有统计学差异（P=0.017）外，术中出血量（60.00 mL vs 65.00 mL）、胸腔引流总量（445.00 mL vs 590.00 mL）、术后3天胸腔引流量[（455.33±318.333）mL vs（422.32±194.95）mL]、术后胸管留置时间（3.50天vs 4.00天）和术后住院时间（6.00天vs 6.00天）、术后并发症发生率（5/30 vs 2/28），两组差异均无统计学意义。结论全胸腔镜肺段切除术段间平面的分离方法中，应用电刀切割手工缝合手术时间相对较长，但安全性不劣于应用切割缝合器机械切割缝合。%Background and objective Complete thoracoscopic segmentectomy gained great attention with the high detection rate of early lung cancer. Electrocautery and stapler are most commonly used in dividing the intersegmental plane in pulmonary segmentectomy. However, few reports comparing the two methods exist;all of which contrapose an open approach because complete thoracoscopic approach is not mentioned. hTe aim of this study is to evaluate and compare the safety and effcacy of the two methods in intersegmental plane dissection during complete thoracoscopic pulmonary segmen-tectomy. Methods A retrospective review of prospectively collected data was obtained for 58 consecutive patients who were treated by segmentectomy between September 2013 and March 2016 at a single center. hTe patients were divided into two groups according to the methods in intersegmental plane dissection. hTirty patients underwent intersegmental plane dissection with electrocautery (electrocautery group), and 28 patients underwent the same process using staplers (stapler group). Pre-operative, intraoperative, and postoperative variables for patients were compared between two groups. Results hTe operative time of electrocautery group was longer than that of the stapler group [(248.70±54.46) min vs (209.39±67.25) min, P=0.017]. Furthermore, no statistical difference was found between two groups in intraoperative blood loss (60.00 mL vs 65.00 mL), total drainage volume (445.00 mL vs 590.00 mL), drainage volume in ifrst 3 days atfer surgery [(455.33±318.333) mL vs (422.32± 194.95) mL], duration of chest tube drainage [(4.20±2.07) d vs (4.11±1.61) d], postoperative hospital stay [(6.33±2.98) d vs (5.89±1.55) d], and incidence of minor postoperative complication [16.7%(5/30) vs 7.1%(2/28)]. Conclusion Although operative time was longer in electrocautery group than in stapler group, using electrocautery for intersegmental plane dissec-tion in complete thoracoscopic segmentectomy appeared to be a very safe and feasible procedure compared with stapler.
展开▼
