Clinical value between axillary thoracotomy and video-assisted thoracoscopic lobectomy in the treatment of patients with lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yi , LI Ji , LUO Lei , YANG Yanhui ,  XIE Xiaoyang

Department of Thoracic Surgery, The First People's Hospital of Neijiang, Neijiang Affiliated Hospital of Chongqing Medical University, Neijiang, 641000, Sichuan, P.R.China;

Corresponding author：

XIE Xiaoyang, Email: 13990559066@163.com

Keywords：

Radical operation of lung cancer; video-assisted thoracic surgery; subaxillary small incision thoracotomy

DOI：

10.7507/1007-4848.201608055

Video：

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Objective To compare the subaxillary small incision thoracotomy (SSIT) with video-assisted thoracic surgery (VATS) for patients with lung cancer. Methods Retrospective analysis of 142 patients with lung cancer in Department of Thoracic Surgery, The First People's Hospital of Neijiang from January 2014 to April 2016 was conducted. There were 86 males and 56 females, aged 40-77 years. Patients were divided into a VATS group (n=72) and a SSIT group (n=70). The following postoperative data were evaluated: operation time, number of dissected lymph nodes, intraoperative bleeding, postoperative chest drainage volume, drainage duration, postoperative ambulation time, average hospital stay, postoperative complications, hospitalization cost, early postoperative incision pain (visual analogue scale, VAS) and other indicators. Results There were no statistically significant differences between the two groups in the operation time (120.8±20.4 minvs. 126.2±21.6 min,P=0.124), the dissected lymph node (11.1±2.0vs. 11.4±1.9,P=0.333) and the postoperative complications rate (13.9% vs. 15.7%, P=0.759). Laparoscopic intraoperative bleeding and postoperative drainage volume were significantly less in the VATS group than those in the SSIT group (123.2±26.9 mlvs. 156.4±24.0 ml,P<0.001; 227.0±75.5 mlvs. 334.3±89.1 ml,P<0.001). Postoperative drainage duration, postoperative ambulation time and hospital stay were shorter in the VATS group than those in the SSIT group (2.5±0.5 dvs. 3.1±0.6 d, 1.5±0.5 dvs. 2.2±0.6 d, 6.5±0.5 dvs. 7.4±0.6 d, allP<0.001). The average hospitalization cost of the VATS group was significantly higher than that of the SSIT group (42 338.9±8 855.7 yuanvs. 32 043.7±7 178.1 yuan,P<0.001). There was no significant difference in the operation cost and anesthesia cost between the two groups (P>0.05). The early postoperative pain of laparoscopic group was less, but the difference was not statistically significant (P>0.05). Conclusion The hospitalization cost of the SSIT is lower than that of thoracic surgery, which may be beneficial to the appilication in primary hospitals.

Citation： WANG Yi, LI Ji, LUO Lei, YANG Yanhui, XIE Xiaoyang. Clinical value between axillary thoracotomy and video-assisted thoracoscopic lobectomy in the treatment of patients with lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(11): 844-848. doi: 10.7507/1007-4848.201608055 Copy

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2.	车国卫, 刘伦旭, 石应康. 加速康复外科临床应用现状与思考. 中国胸心血管外科临床杂志, 2016, 23(3): 211-215.
3.	Hirai K, Takeuchi S, Usuda J. Single-port video-assisted thoracic surgery for early lung cancer: initial experience in Japan. J Thoroc Dis, 2016, 8(3): 44-50.
4.	蒲强, 马林, 车国卫, 等. 单向式胸腔镜肺叶切除安全性及技术可行性研究——附 1040 例报告. 四川大学学报 (医学版), 2013, 44(1): 109-113.
5.	宋志芳, 韩兆杰, 林琳, 等. SF-36 量表评价胸外科住院患者生活质量的信度和效度. 中国胸心血管外科临床杂志, 2014, 21(2): 164-167.
6.	张海, 吴昊, 牟志民, 等. 单孔与三孔法电视胸腔镜治疗原发性肺癌效果的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(4): 346-351.
7.	郝志鹏, 蔡奕欣, 付圣灵, 等. 单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究. 中国肺癌杂志, 2016, 19(3): 122-128.
8.	Lyscov A, Obukhova T, Ryabova V, et al. Double-sleeve and carinal resections using the uniportal VATS technique: a single centre experience. J Thorac Dis, 2016, 8(3): 35-41.
9.	莫辉胜, 潘毓标, 韦力. Ⅰ期肺癌患者的单向式全胸腔镜肺叶切除术效果研究. 中国现代手术学杂志, 2016, 20(1): 30-33.
10.	Pishchik VG, Zinchenko EI, Obornev AD, et al. Video-assisted thoracoscopic anatomic lung resection: experience of 246 operations. Khirurgiia, 2016, 1(2): 10-15.
11.	张志辉, 陈国喜, 邱玉清. 全胸腔镜肺叶切除术中利用常规器械技术替代一次性高值材料的实践与体会. 广东医学院学报, 2012, 30(2): 148-150.
12.	丁国强, 张瑛, 白舒, 等. 经济欠发达地区全胸腔镜肺叶切除术初步体会. 中国微创外科杂志, 2010, 10(6): 508-509.
13.	尉连成, 张明远, 牛子民. 腋下小切口手术治疗肺癌 68 例体会. 中国微创外科杂志, 2005, 5(12): 1003.
14.	彭忠民, 李猛, 孟龙, 等. 微创技术在肺癌支气管/肺动脉成型术中的应用探讨. 中国肺癌杂志, 2009, 12(11): 1139-1142.
15.	周中新, 姜波, 刘京松, 等. 胸腔镜手术中胸膜腔粘连处理体会. 齐齐哈尔医学院学报, 2014, 35(24): 3618-3620.
16.	Suda T, Ashikari S, Tochii S, et al. Single-incision subxiphoid approach for bilateral metastasectomy. Ann Thorac Surg, 2014, 97(2): 718-719.
17.	阳鹏, 吴智宁, 梁剑平, 等. Muscle-sparing 小切口、常规后外侧切口及胸腔镜三孔手术切口在肺癌根治术中的疗效比较. 中国现代手术学杂志, 2016, 20(1): 25-29.
18.	Asteriou C, Lazopoulos A, Rallis T, et al. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study. Ther Clin Risk Manag, 2016, 12(12): 59-65.
19.	龙浩, 林志潮, 林勇斌, 等. 胸腔镜与小切口开胸肺切除术后生活质量的对比性研究. 中国微创外科杂志, 2008, 83(2): 137-139.
20.	Cheng K, Zheng B, Zhang S, et al. Feasibility and learning curve of uniportal video-assisted thoracoscopic segmentectomy. J Thorac Dis, 2016, 8(3): 29-34.
21.	杨梅, 樊骏, 周红霞, 等. 胸腔镜肺癌肺叶切除术后 16F 较 28F 胸腔引流管应用的临床优势. 中国肺癌杂志, 2015, 18(8): 512-517.

1. 支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范(2015 年版). 中华肿瘤杂志, 2015, 37(1): 67-68.
2. 车国卫, 刘伦旭, 石应康. 加速康复外科临床应用现状与思考. 中国胸心血管外科临床杂志, 2016, 23(3): 211-215.
3. Hirai K, Takeuchi S, Usuda J. Single-port video-assisted thoracic surgery for early lung cancer: initial experience in Japan. J Thoroc Dis, 2016, 8(3): 44-50.
4. 蒲强, 马林, 车国卫, 等. 单向式胸腔镜肺叶切除安全性及技术可行性研究——附 1040 例报告. 四川大学学报 (医学版), 2013, 44(1): 109-113.
5. 宋志芳, 韩兆杰, 林琳, 等. SF-36 量表评价胸外科住院患者生活质量的信度和效度. 中国胸心血管外科临床杂志, 2014, 21(2): 164-167.
6. 张海, 吴昊, 牟志民, 等. 单孔与三孔法电视胸腔镜治疗原发性肺癌效果的病例对照研究. 中国胸心血管外科临床杂志, 2016, 23(4): 346-351.
7. 郝志鹏, 蔡奕欣, 付圣灵, 等. 单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究. 中国肺癌杂志, 2016, 19(3): 122-128.
8. Lyscov A, Obukhova T, Ryabova V, et al. Double-sleeve and carinal resections using the uniportal VATS technique: a single centre experience. J Thorac Dis, 2016, 8(3): 35-41.
9. 莫辉胜, 潘毓标, 韦力. Ⅰ期肺癌患者的单向式全胸腔镜肺叶切除术效果研究. 中国现代手术学杂志, 2016, 20(1): 30-33.
10. Pishchik VG, Zinchenko EI, Obornev AD, et al. Video-assisted thoracoscopic anatomic lung resection: experience of 246 operations. Khirurgiia, 2016, 1(2): 10-15.
11. 张志辉, 陈国喜, 邱玉清. 全胸腔镜肺叶切除术中利用常规器械技术替代一次性高值材料的实践与体会. 广东医学院学报, 2012, 30(2): 148-150.
12. 丁国强, 张瑛, 白舒, 等. 经济欠发达地区全胸腔镜肺叶切除术初步体会. 中国微创外科杂志, 2010, 10(6): 508-509.
13. 尉连成, 张明远, 牛子民. 腋下小切口手术治疗肺癌 68 例体会. 中国微创外科杂志, 2005, 5(12): 1003.
14. 彭忠民, 李猛, 孟龙, 等. 微创技术在肺癌支气管/肺动脉成型术中的应用探讨. 中国肺癌杂志, 2009, 12(11): 1139-1142.
15. 周中新, 姜波, 刘京松, 等. 胸腔镜手术中胸膜腔粘连处理体会. 齐齐哈尔医学院学报, 2014, 35(24): 3618-3620.
16. Suda T, Ashikari S, Tochii S, et al. Single-incision subxiphoid approach for bilateral metastasectomy. Ann Thorac Surg, 2014, 97(2): 718-719.
17. 阳鹏, 吴智宁, 梁剑平, 等. Muscle-sparing 小切口、常规后外侧切口及胸腔镜三孔手术切口在肺癌根治术中的疗效比较. 中国现代手术学杂志, 2016, 20(1): 25-29.
18. Asteriou C, Lazopoulos A, Rallis T, et al. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study. Ther Clin Risk Manag, 2016, 12(12): 59-65.
19. 龙浩, 林志潮, 林勇斌, 等. 胸腔镜与小切口开胸肺切除术后生活质量的对比性研究. 中国微创外科杂志, 2008, 83(2): 137-139.
20. Cheng K, Zheng B, Zhang S, et al. Feasibility and learning curve of uniportal video-assisted thoracoscopic segmentectomy. J Thorac Dis, 2016, 8(3): 29-34.
21. 杨梅, 樊骏, 周红霞, 等. 胸腔镜肺癌肺叶切除术后 16F 较 28F 胸腔引流管应用的临床优势. 中国肺癌杂志, 2015, 18(8): 512-517.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical value between axillary thoracotomy and video-assisted thoracoscopic lobectomy in the treatment of patients with lung cancer

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