非小细胞肺癌患者胸腔镜肺叶切除术后复发模式分析  

Analysis of the pattern of recurrence after curative thoracoscopic lobectomy of non-small cell lung cancer

作　　者：齐海亮[1,2] 李晓 隋锡朝[1] 杨帆[1] 姜冠潮[1] 刘军[1] 王俊[1] 李剑锋[1] 

机构地区：[1]北京大学人民医院胸外科,100044 [2]河北省胸科医院胸外科,石家庄050041

出　　处：《中华胸心血管外科杂志》2016年第11期641-644,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：河北省医学科学研究重点课题（20150145）

摘　　要：目的探讨非小细胞肺癌行全胸腔镜肺叶切除术后复发转移的特点，及胸腔镜肺叶切除治疗非小细胞肺癌的效果。方法回顾性分析登记数据库资料，所有患者为非小细胞肺癌，术前临床分期I期，接受全胸腔镜肺叶切除术。总结随访结果，记录局部复发情况、转移性复发情况，并分析与术后复发转移相关的因素。结果从2006年9月至2013年12月，在我中心接受以根治为目的胸腔镜肺叶切除手术的非小细胞肺癌患者共1073例，其中969例患者符合入组条件，除外12例无随访资料者，最终入组957例。随访时间7～94个月，中位随访时间27个月。全组患者总复发率17．6％（168／957），其中远处转移占总复发的46．4％（78／168），局部复发占38．7％（65／168），两者同时出现占14．9％（25／168）。局部复发常见部位依次是：同侧肺（53．8％），纵隔淋巴结（36．6％），同侧胸膜（5．4％），气管残端（3．2％），胸壁伤口（1．1％）；远处转移常见部位依次是：对侧肺（25．4％），骨（25．4％），脑（17．5％），非区域淋巴结（9．5％），肝（9．5％），肾上腺（4．8％），对侧胸膜（1．6％），肾（1．6％），其他部位（4．8％）。单因素分析显示年龄I〉60岁，手术时期，病理分期，肿瘤N分期，肿瘤T分期，以及病理分化程度是影响术后复发转移的因素。结论全胸腔镜肺叶切除治疗非小细胞肺癌安全、有效、可行，患者的局部控制率和远处转移情况等能达到开胸手术的效果。患者术后局部复发最常见的部位是同侧肺和纵隔淋巴结，远处转移最常见的部位是对侧肺、骨和脑。Objective To analysis the recurrence pattern after curative resection by thoracoscopic lobectomy of non-small cell lung cancer. Methods All patients who underwent lobectomy for clinical stageI lung cancer determined by means of computed tomographlc and positron emission tomographic analysis were identified from a prospective database at a single institu- tion. All patients were selected for video-asslsted tboracoscopic surgery. Patients＇ characteristics, perioperative results, and recurrences were recorded. A logistic regression model was constructed to identify variables influencing the development of recurrent disease. Results There were 1 073 NSCLC patients who underwent curative thoracoscopic lobectomy between September 2006 and December 2013. 969 cases were included according to the inclusion criteria. 957 cases were included finally except for 12 cases without any follow-up information. The median follow-up time interval was 27 months （7 -94 months）. The overall recurrent rate is 17.6% （ 168/957 ） , with 46.4% （78/168） distant recurrence, 38.7% （65/168） local recurrence, and 14.9% （25/168） synchronous distant and local recurrence. The most common local recurrent sites were： ipsilateral lung （53.8%）, and mediastinal lymph node （36. 6%）. The most common distant recurrent sites were： contralateral lung （25.4%）, bone（25.4% ）, and brain（ 17.5% ）. Univariate analysis showed that age ≥60 years, operation period, patholog- ic stage, tumor N stage, tumor T staging, and the degree of pathological differentiation were the factors influencing recurrence and metastasis after operation. Conclusion The recurrent pattern of thoracoscopic lobectomy for treating NSCLC is similar to thoracotomy. Thoracscopic lobectomy is a safe, feasible, and effective procedure for non-small cell lung cancer. The most common local recurrent sites are ipsileateral lung and mediastinal lymph node. The most common distant recurrnent sites are contralateral lung, bone and brain.

关 键 词：癌 非小细胞肺 肺切除术 胸腔镜检查 肿瘤复发 局部 肿瘤转移 

分 类 号：R734.2[医药卫生—肿瘤]