Background and objective: In the recent years, uniportal video-assisted thoracic surgery (uniportal-VATS) is developing rapidly on the basis of traditional three portal VATS and has been applied for radical resection of lung cancer, its superiority on the clinical application compared with traditional VATS is also become the focus of the attention, the aim of this study is to preliminary investigate the effect of uniportal -VATS on post-operative pain and short-term quality of life.
Methods: Data of 216 patients who underwent uniportal-VATS (n=115) or three portal VATS (3P-VATS)(n=101) for radical resection of non-small cell lung cancer (NSCLC) were analyzed. The clinical and operative data were assessed, visual analogue scale (VAS) was used to evaluate the minimum and maximum pain score (VASmin and VASmax) on the 3rd and 7th post-operative day. Chinese version 4.0 of Functional Assessment of Cancer Treatment-Lung (FACT-L) was applied to evaluate the short-term quality of life preoperatively and 3 months after operation, respectively. Incidence of incision numbness and satisfaction rate of incision appearance were compared between the two groups 3 months after operation.
Results: Both groups were similar in clinical characteristics, there were no perioperative death in two groups. While the operative time of uniportal-VATS group (157.62±19.50) min was longer than that of the 3P-VATS group [(116.00±17.32) min, P<0.001], the chest tube duration and postoperative hospital stay of uniportal-VATS group [(4.37±1.65) d, (9.87±1.25) d] were both shorter than those of 3P-VATS group [(5.54±1.57) d, (10.43±1.43) d, P=0.020, P=0.004]. No statistically significant difference was reported in VASmin-d3 [(1.98±0.57) vs (2.09±0.59), P=0.148] between the two groups, however, VASmin-d7 and VASmax-d3,d7 were all significantly less in uniportal-VATS group [(1.46±0.29), (3.75±0.54), (2.43±0.53)] than in 3P-VATS group [(1.58±0.30), (3.93±0.51), (2.62±0.62), P=0.003, P=0.011, P=0.018]. FACT-L assessment indicated that the scores of patients' functional status, emotional status and overall quality of life 3 months after the surgery in uniportal VATS group [(20.94±2.22), (19.88±1.70), (108.09±4.58)] were all higher than those in 3P-VATS group [(20.24±1.92), (19.36±1.67), (106.88±4.17), P=0.014, P=0.024, P=0.045], there were no significant differences between the two groups in physical status, social and family conditions as well as in lung cancer subscale. Compared with 3P-VATS group, the incidence of incision numbness was lower (24.3% vs 38.6%, P=0.024) and satisfaction rate of incision was higher (78.3% vs 65.3%, P=0.035) in uniportal-VATS group at the 3 months follow-up.
Conclusion: Compared with 3P-VATS, uniportal-VATS radical lobectomy could reduce post-operative pain and improve short-term postoperative quality of life, it has practical clinical value in surgical therapy of lung cancer .
背景与目的 近年来在传统三孔胸腔镜的基础上，单孔胸腔镜术式发展迅速并渐用于肺癌根治性切除，其与传统胸腔镜术式相比的临床应用优势也为关注的热点。本研究针对单孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的影响进行初步探讨。方法 选取2015年3月-2015年9月在我科同诊疗组连续行单孔胸腔镜（单孔组）或三孔胸腔镜（三孔组）肺癌根治术的非小细胞肺癌患者216例，其中单孔组115例，三孔组101例。对比两组的临床及手术资料，以视觉模拟评分（visual analogue scale, VAS）法评估两组患者术后第3天、第7天时疼痛的最小（VASmin-d3、d7）及最大（VASmax-d3、d7）值，肺癌治疗功能性量表（Functional Assessment of Cancer Treatment-Lung, FACT-L）中文版v4.0评测两组患者术前及术后三月的生活质量，对比两组术后三月切口麻木发生率及患者对切口外观的满意度。结果 两组患者的一般临床资料无差异，均无围手术期死亡病例，单孔组手术时间（157.62±19.50）min较三孔组（116.00±17.32）min更长（P<0.001），但术后胸管置管时间和术后住院时间在单孔组[(4.37±1.65) d, (9.87±1.25) d]均明显短于三孔组[(5.54±1.57) d, (10.43±1.43) d]（P=0.020, P=0.004）；两组患者术后VASmin-d3无显著差异，但单孔组VASmin-d7及VASmax-d3、d7[ (1.46±0.29), (3.75±0.54), (2.43±0.53)]均低于三孔组[(1.58±0.30), (3.93±0.51), (2.62±0.62); P=0.003; P=0.011; P=0.018]。FACT-L评分显示术后三月单孔组患者功能状态、情感状态和整体生活质量得分[ (20.94±2.22), (19.88±1.70), (108.09±4.58) ]均高于三孔组患者[(20.24±1.92), (19.36±1.67), (106.88±4.17); P=0.014; P=0.024; P=0.045]，而生理状态、社会/家庭状态及肺癌相关症状评分两组并无差异。与三孔组比较，单孔组术后三月切口麻木发生率（24.3% vs 38.6%）更低（P=0.024），患者对切口的满意度更高（78.3% vs 65.3%, P=0.035）。结论 与三孔胸腔镜相比，单孔胸腔镜肺癌根治术能够减轻患者术后疼痛，改善术后短期生活质量，在肺癌的外科治疗中有一定临床应用价值。.