Comparative Study Of Different Incision Selection In Three-ports Thoracoscopic Lobectomy

Objective: With the growing population of the world and the trend of population aging,the incidence and mortality of cancer are increasing.In 2017,according to the National Cancer Center of China,lung cancer ranked the top among all kinds of tumors in men,and the second in women.The mortality rate of lung cancer is also the highest.In recent years,the technical means of medical imaging examination have been improved continuously.With the popularity of CT examination,the wide application of high resolution CT,and the recent promotion of low dose CT screening and the awareness of people’s general physical examination,more and more early and middle lung cancer can be found.In the field of treatment in non-small cell lung cancer(NSCLC),surgical treatment is still the most promising treatment for clinical cure.For the early and mid-term treatment of NSCLC,surgery is still considered the best choice.But there is still a dispute over the choice of options for the operation.Surgical treatment strategies generally accepted medicine at present is: lobectomy plus systematic lymph node dissection is recommended for NSCLC patients with general condition,while for patients with poor general conditions or multiple nodules in the lungs,sublobectomy can be used as appropriate.With the rapid development of surgical endoscopy,video-assisted thoracoscopic surgery(VATS)has become the first choice for surgical treatment of NSCLC in the department of thoracic surgery.The methods of operation are various.The most commonly used,effective and convenient method of surgery in the clinic is the threeports VATS.The advantages of this method are: stereotactic the surgery area,coordinate with two operation ports so as not to damage the adjacent tissues,easy to operate with a clear vision,easy to carry out systematic lymphadenectomy.But at the same time there are inadequacies: compared with single-ports or two-ports VATSy,more incisions increased the surgical trauma,and the intraoperative injury of intercostal nerve is greater,and postoperative pain and local skin sensation disorder are common.The practical purpose of this study is explore a safe and effective approach to the surgical incision that has the least trauma and make the patient feel most comfortable in the clinical development of three-port thoracoscopic lobectomy.Methods: From November 2016 to October 2017,150 cases of early and middlestage non-small cell lung cancer were selected,and then the surgical treatment was decided after clinical diagnosis.All patients were treated by thoracoscopic lobectomy plus mediastinal lymph node dissection in a single treatment group.In the study,the subjects were randomly divided into 3 groups to be performed the surgery.The following grouping criteria are as follows,in group A,the conventional three incision thoracoscopic surgery was used,and three incisions were set in three different intercostal spaces.In group B,the operation port and observation port were set in the same intercostal area,the auxiliary operation port was used in the 2cm incision,so it is possible for larger surgical instruments such as endo-GIA to pass through the port.In group C,the operation port and observation port were also be set in the same rib,but the 5mm trocar was used in the auxiliary operation port.Only surgical instruments such as aspirator and ultrasonic scalpel were allowed in this port.The related data we collected include general statistics of patients,operative time,total intraoperative blood loss,intraoperative lymph node dissection and positive rate,first day drainage volume after surgery,drainage tube indwelling time,postoperative complications and postoperative hospitalization time.The visual analogue score(VAS)was used to evaluate the pain of the patients at first,third,fourteenth,and thirtieth days after surgery.The data were analyzed by SPSS 19 software.Variance analysis was used among the data groups,and chi square test was used among the count data groups,and the difference was statistically significant in p<0.05.Results: There was no significant difference in general statistics of patients,operative time,total intraoperative blood loss,intraoperative lymph node dissection and positive rate,first day drainage volume after surgery,drainage tube indwelling time,postoperative complications and postoperative hospitalization time among the three groups(p>0.05).In terms of postoperative pain,there was no significant difference in pain among the three groups at first days after the operation(p>0.05);the degree of pain is lighter in group C at third days after the operation(p<0.05);the pain in group C was less than that in group A(p<0.05),but there was no significant difference between the group B and the other two groups at the fourteenth days after the surgery(p>0.05);at 30 days after the operation,the pain in the A group was significantly higher than that in the other two groups(p<0.05).Conclusion: All study methods are safe and effective in each group.Through the study we found that in the operation,the position of the posterior axillary lineoperation hole is set at the same rib gap with the observation hole,which will not affect the operative performance,but also reduce the stimulation of different intercostal nerves.After operation,it can effectively improve the subjective discomfort caused by pain.Meanwhile,if we use a 5mm trocar as an auxiliary operation hole,then it can reduce the injury of local intercostal muscle and parietal pleural,avoid the repeated passage and adjustment of the large thoracoscopic surgical instruments,reduce the stimulation of the local intercostal nerve,and effectively reduce the pain discomfort in the operation early after the operation.