原発性肺癌に対する単孔式胸腔鏡手術―多孔式胸腔鏡手術との比較・検討

Uniportal versus Multiportal Video-assisted Thoracic Surgery for Primary Lung Cancer

胸腔鏡手術（VATS）が安全で有効な術式であると証明され，広く施行されてきた中で，さらに低侵襲な術式を求めて単孔式胸腔鏡手術（u-VATS）が登場し，少しずつ普及してきている．当科でも2019年2月にu-VATSを導入して解剖学的肺切除術を施行してきた．これらの症例について従来の多孔式VATS（m-VATS）と比較し，その安全性と有用性について検討したので報告する．

Objectives：This study aimed to consider the safety and feasibility of uniportal video-assisted thoracic surgery （VATS） ［u-VATS］ compared with multiportal VATS （m-VATS）.

Methods：Sixty-two patients underwent anatomical lung resection for primary lung cancer via u-VATS between February 2019 and May 2020 at our institution. We performed propensity score matching of these cases versus anatomical lung resection cases under m-VATS performed from January 2017 to December 2019, and compared the perioperative results.

Results：In the u-VATS group, operation time （142 minutes vs. 178 minutes, p＜0.01） and postoperative drainage days （1.6 days vs. 2.4 days, p＝0.01） were significantly shorter. There were no differences in intraoperative blood loss, vascular damage, conversion rate, number of lymph nodes dissected, postoperative complications, and postoperative hospital stay. The number of pain complaints and the number of analgesics （non-steroidal anti-inflammatory drugs：NSAIDs） prescribed at the first outpatient clinic after discharge were significantly lower in the u-VATS group （10 vs. 22, p＝0.03）.

Conclusions：U-VATS shortened the operation time and postoperative drainage period compared with conventional m-VATS, and significantly reduced the use of analgesics. U-VATS is considered to be safe and less invasive surgical procedure based on the present study.