胸腔镜下解剖性部分肺叶切除术与肺叶切除术治疗pT1aN0M0期周围型非小细胞肺癌的近期疗效比较  

Comparison of thoracoscopic anatomical partial-lobectomy and thoracoscopic lobectomy on the patients with pT1aN0M0 peripheral non-small cell lung cancer

作　　者：高树庚[1] 邱斌[1] 李放[1] 谭锋维[1] 赵峻[1] 薛奇[1] 王大力[1] 毛友生[1] 牟巨伟[1] 赫捷[1] 

机构地区：[1]中国医学科学院肿瘤医院胸外科,北京100021

出　　处：《中华外科杂志》2015年第10期727-730,共4页Chinese Journal of Surgery

摘　　要：目的 比较胸腔镜解剖性部分肺叶切除术与胸腔镜肺叶切除术治疗pT1aN0M0周围型非小细胞肺癌的近期疗效及术后肺功能损失情况.方法 对2013年1月至7月在中国医学科学院肿瘤医院胸外科接受胸腔镜解剖性肺切除后经病理证实为pT1aN0M0的周围型非小细胞肺癌191例进行回顾性分析.根据手术方式分为胸腔镜解剖性部分肺叶切除组（71例）和胸腔镜解剖性肺叶切除组（120例）.采用t检验、秩和检验、x2检验和Fisher确切概率法比较两组患者术前一般资料、手术时间、术中出血量、淋巴结清扫数目、术后引流时间、术后引流量、术后住院时间、术后并发症发生率、术后2年复发转移率及术后6个月第一秒用力呼气量占预测值的百分比（FEV1％）减少情况.结果 两组患者均顺利完成手术,组间手术时间、术中出血量、淋巴结清扫数目、术后引流时间、术后引流量、术后住院时间、术后并发症发生率差异均无统计学意义（P＞0.05）.术后2年随访结果显示,两组患者术后2年复发转移率差异无统计学意义（1.4％比1.7％,x2=0.000,P=1.000）.胸腔镜解剖性部分肺叶切除组的FEV1％减少值少于胸腔镜肺叶切除组（14％±4％比16％±4％,t=2.408,P=0.017）.结论 胸腔镜解剖性部分肺叶切除术应用于pT1 aN0M0周围型非小细胞肺癌,安全、有效,其短期疗效与肺叶切除术相当,其肺功能损失少于肺叶切除术.Objective To compare the short-term outcomes and pulmonary function loss between thoracoscopic anatomical partial-lobectomy and thoracoscopic lobectomy on the patients with pTlaN0M0 peripheral non-small cell lung cancer.Methods The clinical data of 191 patients with pT1aN0M0 peripheral non-small cell lung cancer received thoracoscopic anatomical pneumonectomy between January 2013 and July 2013 in Department of Thoracic Surgery,Cancer Hospital Chinese Academy of Medical Sciences was analyze retrospectively.There were 71 patients underwent thoracoscopic anatomical partiallobectomy and 120 patients underwent thoracoscopic lobectomy.Demographic features,operation time,blood loss,number of dissected lymph nodes,chest tube duration,drainage volume,postoperative hospital stay,postoperative complications,two-year progress and pulmonary function loss of FEV1% （percentage of the predicted forced expiratory volume in 1 second）at 6 months were retrospectively reviewed and compared by t test,rank-sum test,x2 test and Fisher exact test.Results There were no significant differences in operation time,blood loss,number of dissected lymph nodes,chest tube duration,drainage volume,postoperative hospital stay,and postoperative complication rate （P 〉 0.05）.The two-year progress rate between two groups did not differ significantly either （1.4% vs.1.7%,x2 =0.000,P =1.000）.Pulmonary function loss of FEV1% at 6 months was significantly smaller in thoracoscopic anatomical partial lobectomy group than thoracoscopic lobectomy group （14% ±4% vs.16% ± 4%,t =2.408,P =0.017）.Conclusions Thoracoscopic anatomical partial-lobectomy is safe and feasible for patients with pT1 aN0M0 peripheral non-small cell lung cancer.It could achieve equal short-term effect and reserve more pulmonary function compared with thoracoscopic lobectomy.

关 键 词：癌 非小细胞肺 胸腔镜检查 肺叶切除术 肺段切除术 解剖性部分肺叶切除术 

分 类 号：R734.2[医药卫生—肿瘤]