探究单孔胸腔镜应用于高龄非小细胞肺癌患者的临床疗效:肺叶、肺段及两者对比分析  

To Explore Clinical Value of Single-port Video-assisted Thoracoscopic Surgery in Elderly Patients with Non-small Cell Lung Cancer:Lobectomy,Segmentectomy and Lobectomy vs Segmentectomy

作　　者：黄麟[1] 郑斌[1] 陈椿[1] 郑炜[1] 朱勇[1] 郭朝晖[1] Lin HUANG, Bin ZHENG, Chun CHEN, Wei ZHENG, Yong ZHU, Chaohui GUO(Department of Thoracic Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou 350001, Chin)

机构地区：[1]福建医科大学附属协和医院,福建350001

出　　处：《中国肺癌杂志》2018年第4期287-295,共9页Chinese Journal of Lung Cancer

摘　　要：背景与目的肺癌的发病率长期位于癌症之首。I期、II期和部分III期非小细胞肺癌(non-small cell lung cancer,NSCLC)的主要治疗方式以手术为主,肺叶切除术与肺段切除术为两类较为常见的手术方式。电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)已广泛应用于临床,单孔电视辅助胸腔镜(single-port videoassisted thoracoscopic surgery,SP VATS)在胸部外科手术中的应用也逐渐被国内外专家所认识和接受。随着社会高龄化程度逐渐加深,这类患者成为NSCLC诊疗的难点。本研究探讨并分析SP VATS肺叶切除术与肺段切除术在治疗高龄NSCLC患者中的临床应用价值。方法回顾性分析福建医科大学附属协和医院胸外科在2014年5月-2016年12月期间行SP VATS肺叶切除与肺段切除的417例患者资料。其中高龄患者139例(肺叶切除124例vs肺段切除15例),非高龄患者278例(肺叶切除248例vs肺段切除30例)。分别比较高龄与非高龄患者行SPVATS肺叶或肺段切除术及高龄患者行肺叶、肺段切除术的围手术期及术后短期恢复情况。结果 SP VATS肺叶切除和肺段切除的比较组中,除在术前合并症患病率上,高龄患者均高于非高龄患者(P<0.05),在其余比较项上无明显差异(P>0.05)。在单孔胸腔镜肺叶切除和肺段切除的高龄患者比较中,可发现淋巴结清扫站数[(7.61±0.21)组vs(5.60±0.35)组]及数目[(20.39±0.97)枚vs(15.40±2.64)枚],差异有统计学意义(P<0.05),而在年龄、术前合并症患病率、平均手术时间、术中失血量却无统计学差异(P>0.05)。虽然在术后并发症发生率上肺叶切除和肺段切除的高龄患者无统计学差异(P>0.05),但是在术后房颤和双下肢静脉血栓发生率上却存在明显差异(P<0.05)。在术后住院时间[(3.18±1.32)天vs(5.04±1.30)天]、胸管放置时间[(7.00±1.31)天vs(5.00±0.74)天]及总住院费用[(70.06±5.23)千元vs(61.20±5.22)千元]上,差异无统计学意义(Background and objective The morbidity of lung cancer has long been the highest in cancer. Stage I, stage II and partly of stage IIl non-small cell lung cancer （NSCLC） are mainly treated by surgery. Lobectomy and segmen- tectomy both are common lung resection methods. Video-assisted thoracoscopic surgery （VATS） has been widely used in clinical, and the apphcation of single-portvideo-assisted thoracoscopic surgery （SP VATS） has gradually been recognized and accepted by professors. With increasing degree of eldly in society eldly patients already have become inceasingly difficulties in the diagnosis and treatment of NSCLC. The aim of this scudy is to explore and analyze clinical value of SP VATS lobectomy and segmentectomy in elderly patients with NSCLC. Methods In this retrospective observational study, the outcomes of 417 consecutive patients who had undergone SP VATS anatomic segmentectomy or lobectomy for NSCLC from May 2014 to December 2016 on department of thoracic surgery in Fujian Medical University Affiliated Union Hospital were examined, including 139 elderly-case （lobectomy vs segmentectomy： 124vs 15） and 278 nonelderly-case （lobectomy vs segraentectomy： 248 vs 30）. The condition ofperioperative period and postoperative short-time recovery could be compared with lobectomy and segmentectomy between elderly and nonelderly cases and lobectomy and segmentectomy in elderly cases. Results The morbidty of preoperative complications was significant difference （P〈0.05） in comparing with elderly and non-elderly patients with NSCLC either in SP VATS anatomic segmentectomy orlobectomy, except others is no significant difference （P〉0.05）. Numbers of dissected lymph nodes and mediastinal nodal stations of SP VATS lobectomy in elderly patients with NSCLC were more than segmentectomy （P〈0.05）, which were （7.61±0.21） vs （20.39±0.97） and （5.60＋0.35） vs （15.40±2.64）. But there was not significant difference between two elderly groups of SP VATS lobectomy and an

关 键 词：单孔胸腔镜 高龄 肺肿瘤 肺叶切除术 肺段切除术 

分 类 号：R734.2[医药卫生—肿瘤]