Minimally invasive lobectomy directed toward frail and high-risk patients: A case-control study
Minimally invasive lobectomy directed toward frail and high-risk patients: A case-control study
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DOI：
10.1016/s0003-4975(99)00467-1
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发表时间：
1999-07-01
影响因子：
4.6
通讯作者：
Curtis, JJ
中科院分区：
文献类型：
--
作者：
Demmy, TL;Curtis, JJ
背景为了比较微创电视胸腔镜手术（VATS）和开胸手术，病例来自一位为有不利风险因素的患者提供VATS的外科医生进行的肺叶切除术。根据年龄、性别、肺叶、侧支和1秒用力呼气量，将开胸手术病例与19例VATS病例配对。11例VATS和5例开胸手术患者有严重活动障碍或1秒用力呼气量减少（< 1.5 L或50%预测值），其危险性高于其他患者。尽管有更多的高危病例，VATS缩短了住院时间（5.3 ± 3.7 vs 12.2 ± 11.1天，p = 0.02），胸管持续时间（4.0 +/- 2.8 vs 8.3 +/- 8.9天，p = 0.06），更早恢复到完全术前活动（2.2 +/- 1.0 vs 3.6 +/- 1.0个月，p < 0.01）。VATS手术无术中并发症，持续229 +/- 59分钟。3周后VATS组的疼痛明显更好（无或轻度，63%对6%;重度，6%对63%; p < 0.01）。两组共发生6例并发症或死亡，与1秒用力呼气量、激素使用、年龄、主动吸烟和上叶切除有关（P < 0.01）。3例VATS死亡仅发生在老年患者中，3例患者的体力状态，其中2例由类固醇使用掩盖的胃肠道相关问题引起。电视胸腔镜肺叶切除术是痛苦较少，并可能提供更快的恢复为体弱或高风险的病人。需要进一步研究，特别是其在严重活动障碍患者中的安全性。(C)1999年，美国胸外科医师协会（Society of Thoracic Surgeons）
Background. To compare minimally invasive video-assisted thoracic surgery (VATS) with thoracotomy, cases were matched from a pool of pulmonary lobectomies performed by one surgeon who offered VATS for patients with unfavorable risk factors.Methods. A thoracotomy case was paired to each of 19 VATS cases by age, sex, lobe, side, and forced expiratory volume in 1 second. Eleven VATS and 5 thoracotomy patients with severe activity impairments or reduced forced expiratory volume in 1 second (< 1.5 L or 50% predicted) were classified as higher risk than the others.Results. Despite more high-risk cases, VATS yielded shorter hospitalizations (5.3 +/- 3.7 versus 12.2 +/- 11.1 days, p = 0.02), chest tube durations (4.0 +/- 2.8 versus 8.3 +/- 8.9 days, p = 0.06), and earlier returns to full preoperative activities (2.2 +/- 1.0 versus 3.6 +/- 1.0 months, p < 0.01). The VATS operations had no intraoperative complications and lasted 229 +/- 59 minutes. Pain 3 weeks later was dramatically better for the VATS group (none or mild, 63% versus 6%; severe, 6% versus 63%; p < 0.01). Six complications or deaths occurred in each group and were related to forced expiratory volume in 1 second, steroid usage, age, active smoking, and upper lobe resection (p < 0.01). Three VATS deaths occurred only in elderly, performance status 3 patients, with two caused by gastrointestinal-related problems masked by steroid use.Conclusions. A VATS lobectomy is less painful and may offer faster recovery for the frail or high-risk patient. Further study, particularly of its safety in severely activity-impaired patients, is warranted. (C) 1999 by The Society of Thoracic Surgeons.