微小N2非小细胞肺癌胸腔镜肺叶切除与同期开胸手术对照研究  

Video-assisted thoracic surgery lobectomy versus open iobectomy for mini pathologic N2 non-small cell lung cancer

作　　者：周文勇[1] 陈晓峰[1] 张雷[1] 张慧君[1] 王海兵[1] 张辉[1] 赵明川[1] 刘鸿程[1] 

机构地区：[1]同济大学附属上海市肺科医院胸外科,200433

出　　处：《中华外科杂志》2011年第9期820-824,共5页Chinese Journal of Surgery

摘　　要：目的研究分析临床分期I期接受胸腔镜肺叶切除，术中意外发现微小纵隔淋巴结转移（N2）的非小细胞肺癌患者的近、远期预后。方法回顾性分析2004年1月至2007年12月术前诊断为早期非小细胞肺癌（cT1-2NOM0，I期），而术中或术后意外发现微小纵隔淋巴结转移（pT1-2N2M0，Ⅲa期）患者263例的临床资料。全部患者接受肺叶切除术＋系统淋巴结清扫根治性治疗。其中接受胸腔镜肺叶切除术63例（腔镜组），男性37例，女性26例，平均年龄（58±11）岁。同期接受开胸肺叶切除术治疗的为200例（开胸组），男性132例，女性68例，平均年龄（59±11）岁。对比上述两组患者的临床特征及近、远期预后。结果全部263例患者平均生存时间（34．9±1．2）个月，中位生存时间31个月。腔镜组平均生存时间（40．3±2．2）个月，中位生存时间37个月；开胸组平均生存时闯（33．1±1．3）个月，中位生存时间29个月。全部患者1、2、3年生存率为92．O％、57．4％、29．3％，腔镜组1、2、3年生存率为92．1％、g2．5％、41．3％，开胸组1、2、3年生存率为92．0％、49．5％、25．5％，两组间差异有统计学意义（x^2=5．58，P=0．018）。结论VATS肺叶切除治疗微小N2非小细胞肺癌是安全、有效的。患者经过术前严格的评估，手术中出现意料之外的纵隔淋巴结转移，通过系统的淋巴结清扫后没有必要中转开胸完成手术。Objective To assess early and late outcomes of patients with minimal mediastinal lymph nodes metastasis N2 non-small cell lung cancer disease unexpectedly detected during the operation, who underwent video-assisted thoracic surgery iobectomy for clinical stage I. Methods This study retrospectively reviewed and analyzed the medical records of 263 patients underwent surgery between January 2004 and December 2007, who were diagnosed as having early-stage non-small cell lung cancer （ clinical stage was cTI-2NOM0, stage I ） before the surgery, but were found to have mini mediastinal lymph nodes metastasis disease （clinical stage was pT1-2N2M0, stage Ilia） unexpectedly detected during the operation and after the operation. All patients underwent lobectomy and systematic lymph nodes dissection as radical treatments. Among them, 63 patients underwent video-assisted thoracic surgery （VATS） lobectomy, including 37 male patients （58.7%） with a mean age of （58 -＋ 11 ） years old. Two hundred patients underwent open thoracotomy lobectomy, including 132 male patients （66%） with a mean age of （59±11 ） years old. To compare and analyze clinical features, early and late outcomes of patients in these two groups. Results A total of 263 patients with an average survival time （34.9 ± 1.2） months （median 31 months）, 63 cases in VATS lobectomy group with an average survival time （40. 3 ± 2. 2 ） months （median 37 months）, 200 cases in open pulmonary lobectomy group with an average survival time （33.1 ± 1.3） months （median 29 months）. The 1-, 2-, 3-year over survival rate of all the patients was 92.0%, 57.4%, 29. 3%. The 1-, 2-, 3-year survival rate of patients in VATS lobectomy group was 92. 1% , 82. 5%, 41.3%. The 1,2,3 year survival rate of patients in thoracotomy lobectomy group was 92.0%, 49. 5%, 25.5%. There was significant difference between the two groups in this factor （x^2 = 5. 58, P = 0. 018）. Conclusions VATS lobectomy is feasibility and safety for unexpected mini N

关 键 词：癌 非小细胞 肺 肺切除术 预后 

分 类 号：R734.2[医药卫生—肿瘤]