胸腔镜下肺段切除术与肺叶切除术治疗肺癌的近期疗效评估  

Short-term Efficacy of VATS Segmentectomy versus Lobectomy for Lung Cancer

作　　者：赵纯[1,2] 曹隆想 张翀[1] 汪路明[1] 胡坚[1] 

机构地区：[1]浙江大学医学院附属第一医院胸外科,杭州310003 [2]浙江省丽水市中心医院胸外科,丽水323000

出　　处：《华中科技大学学报（医学版）》2015年第2期213-216,222,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：浙江省卫生厅资助项目(No.2008A067)

摘　　要：目的评估和分析胸腔镜下肺段切除术与肺叶切除术治疗肺癌的术后近期疗效。方法 122例患者于2013年1月至2013年11月分别行胸腔镜下肺段切除术(n=56)和胸腔镜下肺叶切除术(n=66)。选取用力肺活量(FVC),第1秒用力呼气量(FEVl)作为肺功能的评估指标,比较手术前和术后1个月肺功能的变化;分析两组手术时间、术中出血量、术后感染发生率、术后胸腔引流管留置时间、术后第1天胸液引流量、术后胸液总引流量和术后住院时间。结果胸腔镜下肺段切除组与肺叶切除组术中出血量、术后感染发生率、术后胸腔引流管留置时间、术后第1天胸液引流量和术后住院时间差异均无统计学意义(均P>0.05);与肺叶切除组比较,肺段切除组的手术时间较长,而术后胸液总引流量较少,差异均有统计学意义(P<0.05);比较术后FVC、FEV1,结果表明肺段切除组较肺叶切除组肺功能损失更小,差异有统计学意义(均P<0.05);两组患者术后6个月随访均无复发及死亡。结论胸腔镜下肺段切除术与肺叶切除术术后近期内均安全有效,但胸腔镜下肺段切除术更有利于保护患者肺功能。Objective To evaluate and analyze the short-term efficacy of video-assisted thoracoscopic surgery（VATS）segmentectomy and VATS lobectomy in the treatment of lung cancer, Methods Clinical data of 122 patients who underwent VATS segmentectomy（n = 56） and VATS lobeetomy（n= 66）from Jan. 2013 to Nov. 2013 were retrospectively analyzed. The pulmonary function was compared between the two groups before and one month after the operation, with forced ventilatory capacity（FVC） and forced expiratory volume in the first second（FEV1）as the evaluation indices. Moreover, the operation time, intraoperative blood loss,morbidlty of postoperative infection, postoperative drainage duration, drainage volume on the first day after surgery, total drainage volume and hospital stay after operation were analyzed in the two groups. Results There were no significant differences in intraoperative blood loss, morbidity of postoperative infection, postoperative drainage duration, drainage volume on the first day after surgery and hospital stay after operation between the two groups（P〉0. 05）. The operation time was significantly increased and total drainage volume decreased in the segmentectomy group when compared with the lobectomy group（P〈0.05）. The loss in postoperative pulmonary function was less in segmentectomy group than in lobectomy group（P〈0.05）. Six-month follow-up showed no recurrence and death in the two groups. Conclusion Both VATS segmentectomy and VATS lobectomy are safe and effective in the treatment of lung cancer in the short term. VATS segmentectomy is more beneficial for protecting postoperative pulmonary function.

关 键 词：肺癌 电视辅助胸腔镜手术 肺段切除术 肺叶切除术 肺功能 

分 类 号：R734.2[医药卫生—肿瘤]