摘要
目的评价VATS肺叶切除治疗早期(Ⅰ~Ⅱ期)中央型肺癌的可行性及有效性。方法回顾性分析行VATS肺叶切除治疗的92例中央型肺癌患者(观察组)的临床资料,所有病例病灶无累及主支气管,以同时期相应病例行开胸手术141例作为对照组,采用倾向评分配比方法对所有患者进行1:1配比,最终纳入研究86例,每组各43例。对两组患者的一般资料、手术情况、术后恢复及远期疗效进行比较分析。结果所有患者手术过程顺利,无严重并发症及死亡病例,观察组中转开胸9例,中转率20.9%,其中主动中转5例,被动中转4例。观察组与对照组手术时间比较,差异无统计学意义[(214.7±20.4)min vs(192.5±15.2)min,P>0.05]。观察组术中清扫淋巴结组数及数量均略高于对照组(均P<0.05);术中出血量、术后当天疼痛评分、术后当天胸闭引流量、术后胸闭引流管留置时间、术后并发症发生率及术后住院时间均优于对照组(均P<0.05)。术后病理诊断为高危≥ⅠB期患者予4个周期辅助静脉化疗,观察组完成率优于对照组(90.7%vs 83.7%,P<0.05)。观察组和对照组2年无瘤生存率比较,差异具有统计学意义(73.7%vs 67.5%,P<0.05)。结论VATS肺叶切除治疗早期(Ⅰ~Ⅱ期)中央型肺癌在淋巴结清扫、术中出血、术后疼痛、引流量及引流时间、并发症、住院时间及化疗耐受性等方面优于常规开胸手术,手术安全性更高,远期疗效相仿。
Objective To investigate the feasibility and effectiveness of video-assisted thoracic surgery(VATS)lobectomy for early-stage(Ⅰ-Ⅱstage)central lung cancer.Methods The clinical data of 92 patients with central type lung cancer treated by VATS(the observation group)were retrospectively analyzed.In all the patients the lesion did not involve the main bronchus.And 141 patients undergoing traditional thoracotomy in the same period were enrolled as the control group.By a 1:1 ratio propensity score matching method,43 cases were selected in each group.The general data,surgical conditions,postoperative recovery and long-term curative effect were compared and analyzed between the two groups.Results All patients underwent the operations successfully without serious complications and death.Nine patients were converted to open operation in the observation group,including 5 cases of active transfer and 4 cases of passive transfer,with a conversion rate of 20.9%.There was no significant difference in operative time between the observation group and the control group[(214.7±20.4)min vs(192.5±15.2)min,P>0.05].The number and quantity of lymph node dissection in the observation group were slightly higher than those in the control group(both P<0.05).The amount of intraoperative blood loss,postoperative pain score,postoperative thoracic drainage,time of tube indwelling,postoperative complication rate,and length of hospital stay were obviously better in the observation group than in the control group(all P<0.05).The completion rate of chemotherapy in the observation group was better than that in the control group(90.7%vs 83.7%,P<0.05).The 2-year disease-free survival rate was significantly different between the observation group and the control group(73.7%vs 67.5%,P<0.05).Conclusion For clinical stageⅠ-Ⅱcentral lung cancer,VATS lobectomy is superior to conventional thoracotomy in lymph node dissection,intraoperative blood loss,postoperative pain,drainage and drainage time,complication,length of hospital stay and chemotherapy tolerance.The VATS operation is safer and the long-term effect is similar with conventional thoracotomy.
作者
闵伟伟
张建斌
李鸿伟
沈琦斌
余才华
Min Weiwei;Zhang Jianbin;Li Hongwei;Shen Qibin;Yu Caihua(Department of Cardio-thoracic Surgery,Central Hospital of Huzhou,Huzhou 313000,China)
出处
《实用肿瘤杂志》
CAS
2019年第6期529-533,共5页
Journal of Practical Oncology
