单德深 赵铭 唐海龙

【摘要】 目的：探究单孔胸腔镜下肺亚段/肺段切除术在肺结节<2 cm的老年患者中的临床应用。方法：选取无锡市惠山区人民医院胸外科在2021年6月—2023年6月收治的100例肺结节<2 cm的老年患者作为研究对象，按随机数字表法分为观察组与对照组，每组50例。对照组行单孔胸腔镜下肺段切除术，观察组行单孔胸腔镜下肺亚段切除术。观察两组手术相关指标、术后疼痛程度[视觉模拟评分法（VAS）]及并发症发生情况。结果：观察组手术时间、住院时间均短于对照组，术中出血量与术后引流量均少于对照组，差异均有统计学意义（P<0.05）。两组术后5 d的VSA评分均低于术后1、3 d，术后3 d的VAS评分均低于术后1 d，差异均有统计学意义（P<0.05）；观察组术后1、3、5 d的VAS评分均低于对照组，差异均有统计学意义（P<0.05）。观察组并发症发生率为6.00%，对照组为12.00%，差异无统计学意义（P>0.05）。结论：与单孔胸腔镜下肺段切除术相比，单孔胸腔镜下肺亚段切除术对肺结节<2 cm的老年患者的创伤更小，更加有效地改善手术相关指标，减少术后疼痛。

【关键词】 单孔胸腔镜 肺亚段/肺段切除术 老年肺结节

Clinical Application of Single-port Thoracoscopic Pulmonary Subsegmental/Segmentectomy in Elderly Patients with Pulmonary Nodules <2 cm/SHAN Deshen， ZHAO Ming， TANG Hailong. //Medical Innovation of China， 2024， 21（14）： 0-039

[Abstract] Objective： To investigate the clinical application of single-port thoracoscopic pulmonary subsegmental/segmental resection in elderly patients with pulmonary nodules <2 cm. Method： A total of 100 elderly patients with pulmonary nodules <2 cm who were admitted to the Department of Thoracic Surgery of Wuxi Huishan District People's Hospital from June 2021 to June 2023 were selected as the study subjects， and were divided into observation group and control group according to the random number table method， with 50 cases in each group. The control group underwent single-port thoracoscopic segmental resection， while the observation group underwent single-port thoracoscopic subsegmental resection. The operation-related indexes， postoperative pain degree [visual analogue scale （VAS）] and incidence of complications in the two groups were observed. Result： The operation time and hospital stay in the observation group were shorter than those in the control group， and the intraoperative blood loss and postoperative drainage volume were lower than those in the control group， the differences were statistically significant （P<0.05）. The VSA scores of both groups at 5 days postoperatively were lower than those at 1 and 3 days postoperatively， and the VAS scores at 3 days postoperatively were lower than those at 1 day postoperatively， the differences were statistically significant （P<0.05）; the VAS scores of the observation group at 1， 3 and 5 d after operation were lower than those of the control group， the differences were statistically significant （P<0.05）. The incidence of complications in the observation group was 6.00%， while it in the control group was 12.00%， the difference was not statistically significant （P>0.05）. Conclusion： Compared with single-port thoracoscopic segmentectomy， single-port thoracoscopic subsegmentectomy is less invasive for elderly patients with pulmonary nodules <2 cm， which is more effective in improving surgery-related indicators， reducing postoperative pain.

[Key words] Single-port thoracoscope Pulmonary subsegmental/segmental resection Senile pulmonary nodule

First-author's address： Department of Thoracic Surgery， Wuxi Huishan District People's Hospital， Wuxi 214100， China

doi：10.3969/j.issn.1674-4985.2024.14.009

肺结节是指在肺组织中形成的小型病变或肿块，它们通常呈圆形或椭圆形，并且直径一般小于3 cm[1]。随着老年群体的增加和影像学技术的进步，越来越多的老年患者被发现存在肺结节。这些结节通常是在胸部X线、计算机断层扫描（CT）或其他影像学检查中无意间发现的[2]。老年肺结节通常直径较小，一般小于2 cm[3]。对于老年肺结节患者，及早进行准确的诊断和治疗非常重要。近年来，随着医学技术和手术器械的不断发展，单孔胸腔镜手术在肺部疾病的治疗中得到了广泛应用[4]。文献[5]《中华医学会肺癌临床诊疗指南（2023版）》中指出单孔胸腔镜下肺亚段或肺段切除术被认为是一种适用于一些患者的微创手术选择。单孔胸腔镜下肺亚段/肺段切除术是一种通过单个切口进行的微创外科手术，用于切除肺部的亚段或肺段，这种手术方法相比传统的胸腔镜手术可以减少创伤和疼痛[6]。但关于单孔胸腔镜下肺亚段切除术与肺段切除术在肺结节中的应用效果对比研究较为少见，基于此，本文探究单孔胸腔镜下肺亚段/肺段切除术在肺结节<2 cm的老年患者中的临床应用效果，报道如下。

1 资料与方法

1.1 一般资料

选取无锡市惠山区人民医院胸外科在2021年6月—2023年6月收治的100例肺结节<2 cm的老年患者作为研究对象，纳入标准：（1）年龄≥60岁；（2）符合肺结节的诊断标准[7]；（3）肺结节<2 cm；（4）能耐受手术治疗且符合手术指征。排除标准：（1）伴有严重的心肺功能障碍、肝肾功能不全或其他不能耐受手术的疾病等；（2）合并其他恶性肿瘤；（3）伴有认知或精神障碍，无法正常沟通。按照随机数字表法分为观察组和对照组，各50例。所有患者及家属均知情同意本研究。本研究经过无锡市惠山区人民医院医学伦理委员会审核。

1.2 方法

两组患者均取健侧卧位，行全身麻醉，气管插管单肺通气，常规消毒铺巾。……