单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究

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 3(rd) and 7(th) 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.