全胸腔镜肺叶切除术在临床早期肺癌的应用价值  

Explore the value of video-assisted-thoracoscopic lobectomy for early-stage lung cancer

作　　者：胡定中[1] 林凌[1] 沈宇舟[1] 赵洋[1] 付世杰[1] 

机构地区：[1]上海交通大学附属胸科医院胸外科,200030

出　　处：《上海医学》2010年第9期841-844,共4页Shanghai Medical Journal

摘　　要：目的通过比较全胸腔镜肺叶切除与常规开胸肺叶切除在手术根治性、安全性及患者术后康复方面的差异,探讨全胸腔镜肺叶切除在临床早期肺癌治疗中的应用价值。方法选取2007年1月-2008年12月在上海交通大学附属胸科医院胸外科行全胸腔镜肺叶切除术的80例临床早期肺癌患者为VATS组,同时选取同期行常规开胸肺叶切除术的62例临床早期肺癌患者为OT组。两组患者术前的临床分期均为Ⅰ期。比较两组淋巴结清扫组数、手术时间、术中出血量、术后置管引流时间、术后住院时间、术后并发症发生率及术后第5天的口述疼痛评分的差异。结果两组间淋巴结清扫组数、手术时间、术中出血量、术后住院时间及术后并发症发生率的差异均无统计学意义(P值均>0.05)。VATS组术后置管引流的时间为(3.71±0.56)d、术后第5天的口述疼痛评分为(5.31±1.21)分,均显著低于OT组的(4.82±0.73)d和(7.01±1.65)分(P值均<0.05)。结论对于临床早期肺癌患者,全胸腔镜肺叶切除术的手术根治性、安全性与开胸肺叶切除术相仿,术后康复明显优于开胸肺叶切除术。全胸腔镜肺叶切除术可作为早期肺癌患者的推荐治疗方式。Objective To compare video-assisted-thoracoscopic （VATS） lobectomy with routine open lobectomy for their difference in the radical treatment outcomes, safety and post-operative rehabilitation, so as to explore the value of VATS lobectomy for early stage lung cancer. Methods Totally 80 patients with early stage lung cancer who underwent VATS lobectomy in Shanghai Chest Hospital during Jan 2007 and Dec 2008 were taken as treatment cohort, and 62 patients with early stage lung cancer who underwent routine open lobectomy at the same time period were taken as control cohort. All patients were identified as stage I before operation. χ2-test and bilateral t-test were used to compare the difference between two cohorts in lymph node clearance rate, duration of operation, intraoperative bleeding, post-operative intubation drainage days, hospital stays, post-operative complications, and pain index at day 5 after operation. Results There were no significant differences in lymph node clearance rate, duration of operation, intraoperative bleeding, hospital stays and post-operative complications between the two groups （all P0.05）. However, VATS lobectomy was found to be superior to open lobectomy in post-operative intubation drainage days and pain index at day 5 after operation （[3.71±0.56] d vs. [4.82±0.73] d, 5.31±1.21 vs. 7.01±1.65, both P0.05）. Conclusion VATS lobectomy can achieve a similar result for radical treatment outcome and a safety not inferior to ruotine open lobectomy in patients with early-stage lung cance. VATS lobectomy is superior to open lobectomy in post-operative rehabilitation and it should be recommended for patients with early-stage lung cancer.

关 键 词：胸腔镜肺叶切除 开胸肺叶切除 早期肺癌 

分 类 号：R734.2[医药卫生—肿瘤]