全胸腔镜下袖式肺叶切除术治疗中央型非小细胞肺癌的回顾性队列研究  

Video-assisted thoracoscopic sleeve lobectomy in the treatment of central non-small cell lung cancer: A retrospective cohort study

作　　者：卫锐狮 庄晓飞[3] 郭石平[3] 俞建荣 李新华[1] WEI Ruishi;ZHUANG Xiaofei;GUO Shiping;YU Jianrong;LI Xinhua(Department of Thoracic Surgery,The Second Hospital of Shanxi Medical University,Taiyuan,030001,P.R.China;Department of Thoracic Surgery,Changzhou Cancer Hospital Affiliated to Soochow University,Changzhou,213001,Jiangsu,P.R.China;Department of Thoracic Surgery,Shanxi Cancer Hospital,Taiyuan,030013,P.R.China)

机构地区：[1]山西医科大学第二医院心胸外科,太原030001 [2]苏州大学附属常州肿瘤医院胸外科,江苏常州213001 [3]山西省肿瘤医院胸外科,太原030013

出　　处：《中国胸心血管外科临床杂志》2021年第6期720-724,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：山西省科技厅面上自然基金(201801D121309)。

摘　　要：目的评价全胸腔镜下袖式肺叶切除术治疗中央型非小细胞肺癌的疗效。方法回顾性分析2014年12月至2019年12月于山西医科大学第二医院及山西省肿瘤医院行袖式肺叶切除术105例中央型非小细胞肺癌患者的临床资料,其中男83例、女22例,年龄57.4(32.6~77.8)岁,体重62.5(52.4~79.1)kg。35例行全胸腔镜下袖式肺叶切除术(A组),70例行传统开胸下袖式肺叶切除术(B组)。比较两组患者手术时间、术中出血量、淋巴结清扫数目、术后并发症发生率、术后早期死亡率、术后24 h胸腔总引流量、术后留置胸腔引流管时间、术后24 h疼痛评分、术后住院时间、术后近期(1个月、6个月及1年)生活质量评分及术后3年生存率等。结果两组在手术时间[(228.1±24.7)min vs.(175.0±23.7)min,P=0.02]、术后并发症发生率(28.6%vs. 34.3%,P=0.04)、术后24 h疼痛评分[(3.6±3.5)分vs.(5.9±2.0)分,P=0.03]、术后留置胸腔引流管时间[(5.0±2.9)d vs.(8.4±2.1)d,P=0.04]等方面差异有统计学意义;在术中出血量[(182.5±36.9)mL vs.(189.8±27.5)mL,P=0.34]、淋巴结清扫数目[(11.1±2.6)个vs.(12.3±1.9)个,P=0.49]、术后早期死亡率(2.9%vs. 4.3%,P=0.31)、术后24 h胸腔总引流量[(346.8±91.1)mL vs.(329.8±101.4)mL,P=0.27]、术后住院时间[(7.9±4.2)d vs.(8.5±3.4)d,P=0.39]、术后3年生存率(68.6%vs. 72.9%,P=0.82)等方面差异无统计学意义。结论全胸腔镜下袖式肺叶切除术治疗中央型非小细胞肺癌安全可行,与开胸手术相比术后并发症更少,术后近6个月内身体恢复更快、生活质量更高。术后3年生存率能与开胸手术相似。Objective To evaluate the efficacy of video-assisted thoracoscopic sleeve lobectomy in the treatment of central non-small cell lung cancer.Methods The clinical data of 105 patients with central non-small cell lung cancer who underwent sleeve lobectomy surgery in the Second Hospital of Shanxi Medical University and Shanxi Cancer Hospital from December 2014 to December 2019 were retrospectively analyzed,including 83 males and 22 females,with an average age of 57.4(32.6-77.8)years and weight of 62.5(52.4-79.1)kg.Thirty-five patients received video-assisted thoracoscopic sleeve lobectomy(a group A),and 70 patients received traditional thoracotomy sleeve lobectomy(a group B).The operation time,intraoperative blood loss,number of lymph node dissection,postoperative complication rate,early postoperative mortality,total thoracic drainage volume at 24 hours,time of indwelling chest tube after operation,pain score at 24 hours after operation,postoperative hospital stay,postoperative short-term(1 month,6 months and 1 year)quality of life score and postoperative 3-year survival rate of two groups were compared.Results There was statistical difference in the operation time(228.1±24.7 min vs.175.0±23.7 min,P=0.02),postoperative complication rate(28.6%vs.34.3%,P=0.04),postoperative pain score at 24 h(3.6±3.5 points vs.5.9±2.0 points,P=0.03)and postoperative indwelling chest tube time(5.0±2.9 d vs.8.4±2.1 d,P=0.04)between the two groups.There was no statistical difference in the intraoperative blood loss(182.5±36.9 mL vs.189.8±27.5 mL,P=0.34),number of lymph node dissections(11.1±2.6 vs.12.3±1.9,P=0.49),early postoperative mortality(2.9%vs.4.3%,P=0.31),total thoracic drainage volume at 24 h after surgery(346.8±91.1 mL vs.329.8±101.4 mL,P=0.27),postoperative hospital stay(7.9±4.2 d vs.8.5±3.4 d,P=0.39)and 3-year postoperative survival rate(68.6%vs.72.9%,P=0.82)between the two groups.Conclusion Video-assisted thoracoscopic sleeve lobectomy for the treatment of central non-small cell lung cancer is safe and feasible.C

关 键 词：中央型非小细胞肺癌 全胸腔镜 开胸手术 袖式切除 肺叶切除术 

分 类 号：R734.2[医药卫生—肿瘤]