Efficacy comparison of simultaneous and staged video-assisted thoracoscopic surgery anatomic segmentectomy for bilateral double primary lung cancer
王峰 1万子扬 1罗利华 1郎华
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作者信息
1. 泸州市中医医院胸外科，泸州 646000
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摘要
目的 探讨同期与分期电视辅助胸腔镜手术（VATS）解剖性肺段切除治疗双侧双原发肺癌（DPLC）的临床效果。 方法 回顾性队列研究。回顾性分析2020年2月至2022年8月泸州市中医医院76例行VATS解剖性肺段切除的双侧DPLC患者的临床资料，依据手术方式分为同期双侧胸腔镜手术组（同期组，44例）和分期胸腔镜手术组（分期组，32例）。比较两组术中情况、围术期指标和术后并发症发生情况等。 结果 两组患者性别、年龄、病理分型、术后TNM分期比较，差异均无统计学意义（均P>0.05）。分期组一、二期手术麻醉苏醒时间分别为（11±3）min、（13±4）min，均短于同期组的（16±4）min （t值分别为5.27、3.51，均P<0.05）。同期组放置引流管数量少于分期组两期叠加[（1.9±0.5）根比（2.2±0.5）根，t＝3.40，P＝0.001]。分期组一、二期手术胸腔引流管留置时长、术后总引流量、住院时间、术后首次下地时间和治疗总费用均低于同期组（均P<0.05），分期组两期叠加术后总引流量、住院时间和治疗总费用则均高于同期组（均P<0.05）。术后1个月同期组并发症总发生率高于分期组[18.18%（8/44）比3.13%（1/32）]，差异有统计学意义（χ2＝4.02，P＝0.045）。同期组日常活动能力评分、动脉血氧气分压、动脉血二氧化碳分压、血氧饱和度均低于分期组（均P<0.05）。 结论 分期VATS解剖性肺段切除治疗双侧DPLC并发症少，患者日常活动能力好，但同期双侧胸腔镜手术治疗费用低。临床医生在全面考虑患者身体及经济因素的情况下，可优先选择同期双侧胸腔镜手术。 Objective To explore the clinical efficacy of simultaneous or staged video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for bilateral double primary lung cancer (DPLC). Methods A retrospective cohort study was conducted. The clinical data of 76 patients with bilateral DPLC who underwent VATS anatomic segmentectomy in Luzhou Traditional Chinese Medicine Hospital from February 2020 to August 2022 were retrospectively analyzed, and they were classified into the simultaneous bilateral thoracoscopic surgery group (the simultaneous group, 44 cases) and the staged thoracoscopic surgery group (the staged group, 32 cases) on the basis of the surgical methods. The intraoperative conditions, perioperative indexes and postoperative complications of the two groups were compared. Results There were no statistically significant differences in the gender, age, pathological type,postoperative TNM staging of both groups (all P > 0.05). The anesthesia awakening time of the first and second stages of surgery in the staged group was (11±3) min and (13±4) min, which was shorter than that in the simultaneous group [(16±4) min] ( t values were 5.27 and 3.51, both P < 0.05). The number of drainage tubes placed in the simultaneous group was less than that in the sum of two stages of the staged group [(1.9±0.5) tubes vs. (2.2±0.5) tubes, t = 3.40, P = 0.001]. The duration of thoracic drainage tube retention, the postoperative total drainage flow, the days of hospitalization, the first postoperative landing time, and the total treatment cost in the first and second stages of surgery in the staged group were lower than those in the simultaneous group (all P < 0.05), while the postoperative total drainage flow, the days of hospitalization, and the total treatment cost in the sum of two stages of the staged group were higher than those in the simultaneous group (all P < 0.05). The total incidence of complications in the simultaneous group was higher than that in the staged group 1 month after surgery [18.18% (8/44) vs. 3.13% (1/32)], and the difference was statistically significant ( χ2 = 4.02, P = 0.045). The scores of activities of daily living, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, and blood oxygen saturation in the simultaneous group were lower than those in the staged group (all P < 0.05). Conclusions Staged VATS anatomic segmentectomy for bilateral DPLC has few complications and good ability to perform activities of daily living, whereas the treatment cost of simultaneous bilateral thoracoscopic surgery is low. Clinicians may recommend prioritizing simultaneous bilateral thoracoscopic surgery after comprehensively considering the patients ' physical and economic conditions.
Abstract
Objective To explore the clinical efficacy of simultaneous or staged video-assisted thoracoscopic surgery (VATS) anatomic segmentectomy for bilateral double primary lung cancer (DPLC). Methods A retrospective cohort study was conducted. The clinical data of 76 patients with bilateral DPLC who underwent VATS anatomic segmentectomy in Luzhou Traditional Chinese Medicine Hospital from February 2020 to August 2022 were retrospectively analyzed, and they were classified into the simultaneous bilateral thoracoscopic surgery group (the simultaneous group, 44 cases) and the staged thoracoscopic surgery group (the staged group, 32 cases) on the basis of the surgical methods. The intraoperative conditions, perioperative indexes and postoperative complications of the two groups were compared. Results There were no statistically significant differences in the gender, age, pathological type,postoperative TNM staging of both groups (all P > 0.05). The anesthesia awakening time of the first and second stages of surgery in the staged group was (11±3) min and (13±4) min, which was shorter than that in the simultaneous group [(16±4) min] ( t values were 5.27 and 3.51, both P < 0.05). The number of drainage tubes placed in the simultaneous group was less than that in the sum of two stages of the staged group [(1.9±0.5) tubes vs. (2.2±0.5) tubes, t = 3.40, P = 0.001]. The duration of thoracic drainage tube retention, the postoperative total drainage flow, the days of hospitalization, the first postoperative landing time, and the total treatment cost in the first and second stages of surgery in the staged group were lower than those in the simultaneous group (all P < 0.05), while the postoperative total drainage flow, the days of hospitalization, and the total treatment cost in the sum of two stages of the staged group were higher than those in the simultaneous group (all P < 0.05). The total incidence of complications in the simultaneous group was higher than that in the staged group 1 month after surgery [18.18% (8/44) vs. 3.13% (1/32)], and the difference was statistically significant ( χ2 = 4.02, P = 0.045). The scores of activities of daily living, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, and blood oxygen saturation in the simultaneous group were lower than those in the staged group (all P < 0.05). Conclusions Staged VATS anatomic segmentectomy for bilateral DPLC has few complications and good ability to perform activities of daily living, whereas the treatment cost of simultaneous bilateral thoracoscopic surgery is low. Clinicians may recommend prioritizing simultaneous bilateral thoracoscopic surgery after comprehensively considering the patients ' physical and economic conditions.
关键词
肺肿瘤/肿瘤,多原发性/胸外科手术,电视辅助/解剖性肺段切除/同期手术/分期手术
Key words
Lung neoplasms/Neoplasms, multiple primary/Thoracic surgery, video-assisted/Anatomic segmentectomy/Simultaneous surgery/Staged surgery
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