Ⅰ、Ⅱ期非小细胞肺癌患者微创疗效研究  

The effect of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for clinical stageⅠ/Ⅱnon-small cell lung cancer

作　　者：林富强[1] 林超西[1] 

机构地区：[1]温州医科大学附属第一医院胸外科,浙江温州325000

出　　处：《中国内镜杂志》2015年第6期575-578,共4页China Journal of Endoscopy

摘　　要：目的探讨全胸镜肺叶切除术治疗Ⅰ、Ⅱ期非小细胞肺癌（N SC LC）患者手术安全性及疗效的影响。方法 2009年10月-2011年10月选取行胸外科手术的86例Ⅰ、Ⅱ期N SC LC患者为研究对象,行全胸镜肺叶切除术治疗,对手术情况、并发症发生率、3年总生存率（O S）、无瘤生存（D FS）、无局部区域复发生存（LR FS）及无远处转移生存（D M FS）,并对术后并发症发生的危险因素进行分析。结果术中出血量（202.32±52.24）m l、手术时间（182.32±15.25）m in、术后疼痛评分（4.28±0.39）分、淋巴结清扫个数（11.23±2.52）个、带管时间（5.36±0.85）d和术后住院时间（8.92±1.25）d。经C ox风险模型显示,术前合并症（^O R：4.285;95%C I：1.442-7.023）及手术时间（O R：4.398;95%C I：1.369-7.693）是术后并发症发生的独立危险因素。对患者随访12-36个月,平均随访（28.9±3.8）个月,共有83例患者获得随访,随访率为96.51%,78例满3年,其3年O S、D FS、LR FS、D M FS和复发率分别为79（95.18%）、32（38.55%）、22（26.51%）、25（30.12%）和12（14.46%）。结论全胸镜手术治疗Ⅰ、Ⅱ期N SC LC创伤小、愈后可。术前合并症及手术时间是影响全胸腔镜肺叶切除术后并发症的独立危险因素。【Objective】To explore the effect of lobectomy by video-assisted thoracoscopic surgery versus thoracotomy for clinical stage Ⅰ/Ⅱnon-small cell lung. 【Methods】168 cases of thoracic surgery Ⅰ~Ⅱ NSCLC patients were divided into 82 cases of thoracotomy lobectomy routine treatment（thoracotomy group）, 86 cases of total thoracoscopic lobectomy treatment（totally thoracoscopic group） from October 2009 to October 2011.The surgical cases, the complication rate and 3-year overall survival（OS）, disease-free survival（DFS）, local recurrence-free survival（LRFS）, distant metastasis-free survival（DMFS）, risk factors and postoperative complication of two groups were compared. 【Results】Totally thoracoscopic group blood loss was（202.32 ±52.24）, operation time（182.32 ±15.25） min,postoperative pain score（4.28±0.39） points, the number of lymph node dissection（11.23 ±2.52） months, with a tube time（5.36 ±0.85） d, postoperative hospital stay（8.92 ±1.25） d. The preoperative comorbidities（ O^R ： 4.285, 95% CI：1.442-7.023） and operative time（ O^R ： 4.398, 95% CI： 1.369-7.693） were a totally thoracoscopic postoperative complications independent risk factors. Patients were followed up 12 to 36 months, with an average follow-up time was（28.9±3.8） months, the totally thoracoscopic group consisted of 83 patients were followed-up rate of 96.51%, a totally thoracoscopic 3-year OS, DFS, LRFS, DMFS and relaps e rates were 79（95.18%）, 32（38.55%）, 22（26.51%）, 25（30.12%）, 12（14.46%）, respectively.【Conclusion】The whole thoracic surgery and conventional thoracotomy therapy Ⅰ-Ⅱ stage NSCLC have the same efficacy and safety with the obvious advantages of minimally invasive. Preop-erative complications and operative time thoracotomy lobectomy is an independent risk factor for postoperative complications.

关 键 词：全胸镜肺叶切除术 开胸肺叶切除 非小细胞肺癌 疗效 

分 类 号：R734.2[医药卫生—肿瘤]