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Objective To compare clinical indicators of the completely video-assisted thoracoscopic surgery(VATS) lobectomy with conventional lobectomy in patients, analysis the clinical effects of completely VATS lobectomy and summarize the related experience.Methods Retrospective analysis 176 patients with pulmonary diseases who underwent complete VATS lobectomy or conventional lobectomy from September 2007 to May 2009 in our hospital. Among the cases, 95 patients underwent complete VATS lobectomy, the others underwent conventional. The complete VATS group owns 55 males and 40 females aged 21-71 years, average (57.8±11.2) years. Among them, 26 underwent right upper lobectomy, 8 underwent right middle lobectomy, 21 underwent right lower lobectomy, 17 underwent left upper lobectomy, 23 underwent left lower lobectomy. Traditional group owns 43 males and 38 female, aged 26-77 years, average (55.3±14.7) years. Among them, 21 underwent right upper lobectomy, 9 underwent right middle lobectomy, 14 underwent right lower lobectomy, 11 underwent left upper lobectomy, 26 underwent left lower lobectomy. Mediastinal and hilar lymph node dissection was simultaneously performed in tall patients with lung cancer. Compared the two groups in operative time, blood loss, number of lymph node dissection, Oxycodone & Acetaminophen tablets used, sum of fluid in the first 3 days, postoperative closed thoracic drainage time, postoperative hospitalization, cost of surgery, number of complications, postoperative recurrence of tumor metastasis and other indicators, and evaluate the merits of thoracoscopic surgery group.Results Both groups were performed successfully completed. 1 case in complete VATS group conversion to open surgery because of the lymph nodes adhere to pulmonary artery, which can not be separated in the endoscopic. Operative time (165.6±51.9) min, blood loss (183.5±76.5) ml, number of lymph node dissection (12.0±4.2), Oxycodone & Acetaminophen used (5.8±3.6) tablets, sum of fluid in the first 3 days (768.3±447.6) ml, closed thoracic drainage time (5.6±3.8) d, postoperative hospitalization (9.4±1.8) d, cost of surgery(3760.8±914.8)yuan; Traditional group hold Operative time (167.7±35.5) min, blood loss (213.2±100.7) ml, number of lymph node dissection(10.2±4.5), Oxycodone & Acetaminophen used (8.7±5.7) tablets, sum of fluid in the first 3 days (1006.0±393.9) ml,closed thoracic drainage time (7.5±2.6) d, postoperative hospitalization (12.8±2.0) d, cost of surgery(3035.8±676.5)yuan;. Followed up 4 to 88 weeks, 2 postoperative patients with primary lung cancer in complete VATS group were 24 and 36 weeks occurrence distant metastases,and 2 in traditional group were 18 and 44 weeks occurrence distant metastases.Conclusion The effect between the two groups in treating lung diseases is the same. The effect and technical in completely VATS lobectomy is feasible. Completely VATS lobectomy with security, minimally invasive, rapid recovery characteristics, advantages over traditional surgery for early peripheral lung cancer and pulmonary diseases needed underwent lobectomy, but requires proficient skills to manage blood vessels and performe lymph node dissection in endoscopic. The establishment of good minimally consciousness can be effective in reducing postoperative complications.
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