胸腔镜辅助与传统肺癌根治术中纵隔淋巴结清扫的效果比较  

Mediastinal lymph node dissection by video -assisted thoracoscopic surgery versus thoracotomy in the treat-ment of lung cancer

作　　者：吴科杰[1] 方万强[1] 方子文[1] 付春利[1] 邓国敏[1] 

机构地区：[1]广东医学院附属开平市中心医院胸心外科,广东省开平529300

出　　处：《中国基层医药》2016年第10期1503-1505,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：比较胸腔镜辅助下（VATS）与传统开胸行肺癌根治术在纵隔淋巴结清扫方面的效果。方法选择手术治疗的非小细胞肺癌患者96例，并根据患者接受的手术方式分为开胸组和 VATS 组，比较两组清扫出纵隔淋巴结的数量，并比较两组手术时间、出血量、胸管放置时间、总住院时间及手术并发症的差别。结果通过对照分析，在 VATS 组和开胸组中，解剖出的总纵隔淋巴结数为：（27．2±7．4）个和（28．8±10．6）个（P ＝0．507），而 N1组肺淋巴结数为：（9．4±4．0）个和（8．3±4．6）个（P ＝0．323），N2组纵隔淋巴结数为：（18．5±6．9）个和（21．3±9．9）个（P ＝0．201），差异均无统计学意义（均 P ＞0．05）。而在术后住院天数、胸管留置天数方面：开胸组分别为（8．1±3．9）d 和（7．3．±4．4）d，VATS 组分别为（6．8±3．5）d 和（5．6±3．5）d，均显示出 VATS 组较开胸组有明显的优势（均 P ＜0．05），而在术中出血量（≥400 mL）及围术期输血率方面：开胸组分别为27．38％和25．00％，VATS 组分别为7．03％和8．60％，开胸组均较 VATS 组高。结论在成熟的开展胸腔镜下肺癌根治术后，在纵隔淋巴结清扫方面，VATS 下的肺癌根治术可以达到与开胸下的肺癌根治术同样的效果，而在并发症方面有更好的优越性。Objective To compare the effect of mediastinal lymph node dissection by video -assisted thora-coscopic surgery （VATS）with thoracotomy in the treatment of lung cancer.Methods 96 patients with non -small cell lung cancer were collected.Patients undergoing VATS were matched with those undergoing thoracotomy in terms of gender,age,clinical tumor stage,tumor location and surgical procedure.Results After matching,48 patients in VATS group and 48 patients in open group were eligible for analysis.In the VATS and open groups,the mean total numbers of dissected lymph nodes were （27.2 ±7.4）and （28.8 ±10.6）（P =0.507）,the numbers of N1 nodes were （9.4 ±4.0）and （8.3 ±4.6）（P =0.323）.And the number of N2 nodes was similar between the VATS and open group [（18.5 ±6.9）vs （21.3 ±9.9）,P =0.201].No significant differences were observed between the two groups（all P 〉0.05 ）.But the days of the postoperation and the chest tube indwelling in thoracotomy group were （8.1 ±3.9）and （7.3 ±4.4）days,which in the VATS group were （6.8 ±3.5）and （5.6 ±3.5）,the VATS group had more advantages than the thoracotomy group（P 〈0.05）.The intraoperative blood loss more than 400mL and peri-operative blood transfusion rate of the thoracotomy group were 27.38% and 25.00%,those of the VATS group were 7.03% and 8.60% respectively,which in thoracotomy group were higher than the VATS group.Conclusion Under-go our retrospective study,after mature VATS to treat lung cancer,with regard to the number of the dissected lymph nodes,VATS lobectomy can achieve complete mediastinal lymph node dissection compared with the traditional approach.There are more advantages by VATS in the complications.

关 键 词：非小细胞肺癌 纵隔淋巴结 VATS 开胸 

分 类 号：R734.2[医药卫生—肿瘤]