单孔胸腔镜解剖性肺段切除与肺叶切除治疗Ⅰa期非小细胞肺癌近期疗效比较  

The Comparison of Short-term Effect between Unipotal Video-assisted Thoracoscopic Anatomic Segmentectomy and Lobectomy for Stage Ⅰa Non-small Cell Lung Cancer

作　　者：张博友 刘宇康 钱邦伦 史宏灿 刘文亮[1] ZHANG Bo-you;LIU Yu-kang;QIAN Bang-lun;SHI Hong-can;LIU Wen-liang(Department of Thoracic Surgery,Second Xiangya Hospital,Central South of University,Changsha 410011,Hunan,China;Department of Cardiothoracic Surgery,Clinical Medical College,Yangzhou University,Yangzhou 225001,Jiangsu,China;Key Laboratory of Integrative Medicine in Geriatrics Control of Jiangsu Province,Yangzhou University,Yangzhou 225009,Jiangsu,China;Translational Medicine Research Center,Yangzhou University,Yangzhou 225009,Jiangsu,China)

机构地区：[1]中南大学湘雅二医院胸外科,湖南长沙410011 [2]扬州大学临床医学院胸心外科,江苏扬州225001 [3]江苏省中西医结合老年病防治重点实验室,江苏扬州225009 [4]扬州大学转化医学研究中心,江苏扬州225009

出　　处：《中国现代手术学杂志》2019年第5期354-359,共6页Chinese Journal of Modern Operative Surgery

基　　金：国家自然科学基金(面上项目81370118,81770018);中南大学中央高校基本科研业务费专项资金资助(中南大学研究生自主探索创新项目2019zzts359)

摘　　要：目的比较单孔胸腔镜解剖性肺段切除术与单孔胸腔镜解剖性肺叶切除术两种手术方式治疗Ⅰa期非小细胞肺癌(NSCLC)的近期疗效。方法回顾选取2018年10月~2019年4月中南大学湘雅二医院行单孔胸腔镜手术治疗的Ⅰa期NSCLC患者共32例,按手术方式分为两组:行单孔胸腔镜解剖性肺段切除手术17例(肺段切除组),其中左肺6例,包括S1+S2切除3例,S6切除1例,S8+S9切除1例,S10切除1例;右肺11例,包括S1切除5例,S1+S2切除1例,S3切除1例,S6切除2例,S6+S7+S8切除1例,S2+S7+S8切除1例;行单孔胸腔镜肺叶切除术15例(肺叶切除组),其中左肺3例,包括左上肺切除1例及左下肺切除2例;右肺12例,包括右上肺切除3例,右中肺切除4例,右下肺切除5例。记录并比较两组患者围手术期指标及术后随访结果。结果组间比较,单孔胸腔镜肺段切除组术后12h及48h引流量少于单孔胸腔镜解剖性肺叶切除组,N2淋巴结清扫数量及纵隔淋巴结清扫总数少于单孔胸腔镜解剖性肺叶切除组,差异均有统计学意义(P<0.05)。而两组住院费用、术中耗材费用、引流管拔管时间、术后住院日、手术时间、N1淋巴结清扫站数及个数、N2淋巴结清扫站数、纵隔淋巴结清扫总站数及术后并发症比较,差异均无统计学意义(P>0.05)。术后病理检查淋巴结均无转移,随访时间1~7个月均未发现肿瘤复发、远处转移及相关死亡。结论单孔胸腔镜肺段切除术治疗Ⅰa期NSCLC安全有效,可以达到与肺叶切除相近的效果,更利于患者术后快速康复。其远期效果尚需进一步研究证实。Objective To compare the safety and short-term effect of uniportal VATS anatomic segmentectomy and uniportal VATS anatomic lobectomy for the stageⅠa non-small cell lung cancer(NSCLC).Methods A total of 32Ⅰa NSCLC consecutive patients admitted from October 2018 to April 2019 in the Second Xiangya Hospital of Central South University were enrolled and analyzed retrospectively.According to surgical procedures,all 32 cases were divided into two groups:17 patients as uniportal VATS-SE group were performed the uniportal VATS anatomic segmentectomy,including the resection segmental located in left lung of 6 cases(3 of S1+S2 resection,1 of S6 resection,1 of S8+S9 resection and 1 of S10 resection)and located in right lung of 11 cases(5 of S1 resection,1 of S1+S2 resection,1 of S3 resection,2 of S6 resection,1 of S6+S7+S8 resection and 1 of S2+S7+S8 resection).15 patients as the uniportal VATS-LE group were carried out the uniportal VATS lobectomy,including the resection lobe located in left lung of 3 cases(1 of left upper lung and 2 of left lower lung)and in right lung of 12 cases(3 of right upper lung,4 of right middle lung and 5 of right lower lung).Results Compare to the uniportal VATS-LE group,the post-operative drainage volume of 12 h and 48 h,the numbers of N2 lymph nodes dissection and total numbers of mediastinum lymph node dissection were less in the uniportal VATS-SE group,and all the differences were statistically(P<0.05).There was no statistical difference in the expense of hospitalization,the cost of intra-operative material,the time of drainage extubation,the duration of hospital stays,the time of operation,the dissection numbers of N1 lymph nodes,the dissection stations of N1,N2 and total lymph nodes of mediastinum and post-operative complication between two groups(P>0.05).No lymph nodes metastasis revealed by post-operative pathological exam.There was no recurrence,distant metastasis and related death during the follow-up period of 1 to 7 months.Conclusions The surgery of uniportal VATS segmentectomy i

关 键 词：单孔胸腔镜手术 肺段切除术 肺叶切除术 非小细胞肺癌 

分 类 号：R734.2[医药卫生—肿瘤]