肺叶切除术和亚肺叶切除术治疗早期非小细胞肺癌的临床效果及对短期预后的影响  

Clinical Effect of Pulmonary Lobectomy and Sublobectomy in the Treatment of Early Non-small Cell Lung Cancer and Their Influence on Short-term Prognosis

作　　者：杨兵 胡文文 孙仲涛[1] 周静 韩焱楠 李文彬[1] YANG Bing;HU Wen-wen;SUN Zhong-tao;ZHOU Jing;HAN Yan-nan;LI Wen-bin(Department of Thoracic Surgery,Fuyang People's Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]阜阳市人民医院胸外科,安徽阜阳236000

出　　处：《临床误诊误治》2020年第9期97-101,共5页Clinical Misdiagnosis & Mistherapy

基　　金：阜阳市卫生健康委科研立项课题(FY2019-029)。

摘　　要：目的探讨肺叶切除术和亚肺叶切除术治疗早期非小细胞肺癌(non-small-cell lung cancer,NSCLC)的临床效果及对短期预后的影响。方法分析2014年12月—2017年12月收治的117例Ⅰa期(TNM分期为T1N0M0)NSCLC的临床资料,根据手术方式不同,分为观察组(n=48)与对照组(n=69)。观察组行亚肺叶切除术,对照组行肺叶切除术。记录一般资料,观察手术相关情况(手术时间、淋巴结采样情况、术中失血量、术后住院时间、术后胸腔封闭引流时间>48 h情况、术后并发症情况、术后联合放疗情况)。所有患者均随访2年,随访终点事件为死亡或失访,分析患者生存情况,观察影响预后的相关因素。结果与对照组比较,观察组年龄大,术前第1秒用力呼气量(FEV1)/用力肺活量(FVC)降低,手术时间、术后住院时间缩短,淋巴结采样所占比例、术后胸腔封闭引流时间>48 h所占比例降低,术中失血量减少,差异有统计学意义(P<0.05或P<0.01)。随访期间,对照组总生存率显著高于观察组,差异有统计学意义(P<0.01)。多因素Cox分析显示,年龄>70岁、有临床症状、未行淋巴结采样、术后联合放疗、手术方式为亚肺叶切除术是影响早期NSCLC患者预后的独立因素(P<0.05或P<0.01)。结论肺叶切除术与亚肺叶切除术治疗早期NSCLC均能取得一定效果,但前者生存获益更高,且年龄、有无临床症状、是否进行淋巴结采样、是否术后联合放疗及不同手术方式是影响早期NSCLC患者预后的相关因素。Objective To explore the clinical value of pulmonary lobectomy and sublobectomy in the treatment of early non-small cell lung cancer(NSCLC)and their influence on short-term prognosis.Methods Clinical data of 117 patients with stageⅠa NSCLC(TNM stage T1N0M0)who were admitted and treated in our hospital between December 2014 and December 2019 were retrospectively analyzed.According to the operation method,the patients were divided into observation group(n=48,sublobectomy)and control group(n=69,pulmonary lobectomy).General data of the patients were recorded,and operation-related conditions(duration of operation,lymph node sampling,intraoperative blood loss,postoperative hospital stay,the proportion of postoperative thoracic sealing drainage time>48 h,postoperative complications and postoperative combined radiotherapy)were observed.All patients were followed up for two years,with death or loss to follow-up as the end-point event.Survival of the patients was analyzed,and relevant factors affecting the prognosis were observed.Results Patients in the observation group were older than those in the control group.The percentage of forced expiratory volume in 1 second(FEV1)to forced vital capacity(FVC)of the observation group was lower than that of the control group before operation.In addition,the duration of operation,postoperative hospital stay,the proportion of lymph node sampling,the proportion of postoperative thoracic sealing drainage time>48 h and intraoperative blood loss were shorter,lower or less than those of the control group(P<0.05 or P<0.01).The overall survival rate of the control group was significantly higher than that of the observation group during the follow-up(P<0.01).Multivariate COX analysis showed that age>70 years,presence of clinical symptoms,failure in lymph node sampling,postoperative radiotherapy and operation method were independent factors affecting the prognosis of patients with early NSCLC(P<0.05 or P<0.01).Conclusion Both pulmonary lobectomy and sublobectomy are effective in the treatmen

关 键 词：癌 非小细胞肺 肺切除术 住院时间 用力呼气量 年龄 放疗 

分 类 号：R734.2[医药卫生—肿瘤]