摘要
目的探讨单向式全胸腔镜肺叶切除术治疗非小细胞肺癌（NSCLC）患者的临床效果。方法回顾性分析2006年6月至2009年12月成都市第二人民医院采用电视胸腔镜手术（VATS）行肺叶切除加纵隔淋巴结清扫治疗89例早期NSCLC患者的临床资料,根据手术方式不同分为两组,VATS辅助组：46例,男36例,女10例;年龄58.76±14.78岁,采用VATS辅助小切口手术;单向式VATS组：43例,男37例,女6例;年龄61.34±12.56岁,行单向式全VATS。选择同期行常规经胸后外侧切口开胸手术患者作为对照（开胸组,42例,男37例,女5例;年龄56.30±15.59岁）。比较3组患者的手术时间？术中出血量？纵隔淋巴结清扫的数量？术后胸腔引流量、并发症发生、胸痛视觉模拟评分（VAS）和生存率的改变。结果 3组均无手术死亡,3组间胸腔引流时间（P=0.024）、胸腔引流量（P=0.019）、术中出血量（P=0.009）、早期下床活动时间（P=0.031）和心肺并发症发生率（P=0.048）差异有统计学意义。单向式VATS组胸腔引流量（208.33±50.39 ml vs.245.98±45.32 ml）、术中出血量（78.79±24.23 mlvs.112.63±64.32 ml）和早期下床活动时间（2.31±0.27 d vs.3.56±0.31 d）较VATS辅助组明显减少（P〈0.05）。开胸组使用杜冷丁患者的比率较VATS辅助组和单向式VATS组明显增加（P=0.046,0.007）,3组患者手术后VAS评分变化差异有统计学意义（F=5.796,P=0.002）。术后随访109例（包括VATS辅助组37例、单向式VATS组37例、开胸组35例）,随访时间2~48个月,失访22例。随访期间VATS辅助组、单向式VATS组和开胸组分别死亡10例、9例和8例;中位生存时间分别为40个月、37个月和37个月;3组患者生存时间差异无统计学意义（P=0.848）。结论 VATS特别是单向式全VATS肺叶切除加系统纵隔淋巴结清扫术在早期NSCLC患者的手术治疗中与传统开胸手术的效果几乎相同,且创伤更小、恢复快,是治疗早期肺癌的可靠方法。
Objective To investigate the effect of single-direction lobectomy plus systematic lymph-node dissection for primary non-small cell lung cancer（NSCLC） in the early stage by video-assisted thoracic surgery（VATS）.Methods We retrospectively analyzed the clinical data of 89 patients who received VATS lobectomy plus systematic lymph-node dissection for early-stage primary NSCLC in the Second People＇s Hospital of Chengdu between June 2006 and December 2009.Based on the operative approach,the patients were divided into two groups： VATS-minithoracotomy group and single-direction lobectomy VATS group.In the former group,there were 46 patients,including 36 males and 10 females,with an age of 58.76±14.78 years.For patients in this group,minithoracotomy was carried out assisted by VATS.In the latter group,there were 43 patients,including 37 males and 6 females,with an age of 61.34±12.56 years,and single-direction lobectomy VATS was performed for patients in this group.Moreover,42 patients undergoing routine posterior lateral open thoracotomy were chosen to form the control group（thoracotomy group,included 37 males and 5 females with an age of 56.30±15.59 years）.The clinical features,such as operative time,operative blood loss,the number of systematic dissected lymph nodes,postoperative drainage quantity,post-operative complications and visual analogue scale（VAS） of chest pain were retrospectively analyzed to evaluate the early outcomes.Results No operative death occurred in all three groups.There were significant differences among the three groups in the postoperative drainage time（P=0.024）,postoperative drainage quantity（P=0.019）,operative blood loss（P=0.009）,early out-ofbed activity time（P=0.031）,and the incidence of cardiopulmonary complications（P=0.048）.Compared with the VATS-minithoracotomy group,the single-direction lobectomy VATS group was significantly lower or shorter（P0.05） in postoperative drainage quantity（208.33±50.39 ml vs.245.98±45.32 ml）,operative blood loss（78.79±24.23 ml vs.112.63±64.32 ml）,and the early out-of-bed activity time（2.31±0.27 d vs.3.56±0.31 d）.The rate of using Dolantin in the control group was significantly higher than the other two groups（P=0.046,0.007）.The change of VAS score among the three groups after operation was also statistically significant（F=5.796,P=0.002）.A total of 109 patients（37 in the VATS-minithoracotomy group,37 in the single-direction lobectomy VATS group,and 35 in the control group） were followed up after operation with a period of 2 to 48 months.Twenty-two patients were lost in the follow-up.There were 10,9,and 8 deaths during the follow-up in the three groups respectively,and the median survival time was 40 months,37 months,and 37 months respectively.There was no significant difference among the three groups in survival time（P=0.848）.Conclusion VATS,especially VATS assisted single direction lobectomy and systematic lymphnode dissection for primary NSCLC in the early stage has the same surgical efficacy as the traditional open thoracotomy,and is minimally invasive,which contributes to a quick recovery.Consequently,it is a reliable approach for lung cancer in the early stage.
出处
《中国胸心血管外科临床杂志》
CAS
2011年第3期231-235,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
早期
非小细胞肺癌
单向式全胸腔镜肺叶切除术
淋巴结清扫术
Early stage
Non-small cell lung cancer
Video-assisted thoracic surgery single direction lobectomy
Systematic lymph-node dissection
