靳智勇 郭占林 康世荣

[摘要] 目的 分析单孔与三孔胸腔镜行肺癌根治术的临床疗效、相关事件指标及对视觉模拟评分（VAS）的影响。方法 选取2016年1月～2018年1月在内蒙古医科大学附属医院接受治疗的100例肺癌患者临床资料，按不同术式分为观察组与对照组，每组50例，对照组行三孔胸腔镜肺癌根治术，观察组行单孔胸腔镜肺癌根治术，比較两组手术情况、疼痛、血清检测指标。 结果 与对照组比较，观察组出血量、引流量明显减少，切口长度、引流管留置时间、住院时间均明显缩短（P < 0.01）；观察组术后第1、3、5天的VAS评分均低于对照组（P < 0.01），术后血清C反应蛋白（CRP）和降钙素原（PCT）含量均少于对照组（P < 0.05），术后IgA、IgG、IgM水平及CD3+、CD4+、CD4+/CD8+指标均高于对照组（P < 0.01）；观察组并发症发生率低于对照组（P < 0.05）。 结论 与三孔胸腔镜肺癌根治术比较，单孔胸腔镜肺癌根治术具有微创、出血量少、恢复快、并发症少等优势，并能彻底清除淋巴结，对患者术后机体的应激、免疫状态的刺激均较轻，是治疗肺癌的有效术式。

[关键词] 单孔胸腔镜；三孔胸腔镜；肺癌根治术；VAS评分；并发症

[中图分类号] R734 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0120-05

[Abstract] Objective To analyze the clinical efficacy， related incident index and visual analogue scale （VAS） scores of single and three-hole thoracoscope applied in radical lung cancer surgery. Methods The clinical data of 100 patients with lung cancer treated in the the Affiliated Hospital of Inner Mongolia Medical University from January 2016 and January 2018 were selected. According to different surgeries performed， they were divided into observation group and control group， with 50 cases in each group. Patients in the control group received radical lung cancer surgery with three-hole thoracoscope， while those in the observation group received radical lung cancer surgery with single-hole thoracoscope. The situation of surgery， pain， detected serum indicators were compared between the two groups. Results Compared with the control group， the blood loss and drainage volume were less， and the length of incision was shorter， the indwelling of drainage tube and hospitalized time were shorter in the observation group （P < 0.01）. The VAS scores at the 1st， 3rd and 5th day after operation in the observation group were lower than those in the control group （P < 0.01）. The postoperative content of C-reactive protein （CRP） and proealcitonin （PCT） in the observation group were less than those in the control group （P < 0.05）. The postoperative levels of IgA， IgG， IgM， CD3+， CD4+， CD4+/CD8+ in the observation group were higher than those in the control group （P < 0.01）. The incidence of complications in the observation group was lower than that in the control group （P < 0.05）. Conclusion Compared with radical lung cancer surgery with three-hole thoracoscope， single-hole thoracoscopic surgery has advantages of smaller invasion， less blood loss， more rapid recovery and fewer complications， it can completely clean lymph nodes， and causes less impact on the patients′ stress and immune status after surgery. It is effective surgical method.

[Key words] Single-hole thoracoscope； Three-hole thoracoscope； Radical lung cancer surgery； VAS scale； Complications

在肺部恶性肿瘤中，肺癌极为常见，其发病率、死亡率逐年呈递增趋势，其病变位置在支气管黏膜上皮[1]。

近几年，电视胸腔镜（video-assisted thoracoscopic，VATS）因其具有微创、疼痛轻、恢复快、应激少等优势，在胸外科领域中应用广泛，且受到医患双方的共同认可[1-4]。VATS手术包括3孔或4孔，无论术式大小，对患者免疫功能产生影响，并可增加感染率，影响术后恢复[5]。随着微创医疗技术的逐步完善，单孔胸腔镜手术（Uniporal-VATS）在肺癌根治术中逐渐展开，该术式仅保留单个操作孔，无辅助性操作孔，能减少胸壁神经、周围组织损伤，并降低术后疼痛，亦能达到良好的治疗效果[6]。为此，本研究以内蒙古医科大学附属医院（以下简称“我院”）接诊的肺癌患者为研究对象，研究单孔、三孔胸腔镜根治术的疗效，现报道如下：

1 资料与方法

1.1 一般资料

选取2016年1月～2018年1月在我院接受治疗的100例肺癌患者临床资料，纳入标准：经胸CT或MRI、术后病理检查均证实肺癌，且符合《中国原发性肺癌诊疗规范》[7]中肺癌诊断标准；……