肺段切除术和肺叶切除术治疗直径≤2cm且术中冰冻证实微乳头和实性亚型阴性肺腺癌的多中心随机对照研究  

Comparison of segmentectomy versus lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections:A multi-center randomized controlled trial

作　　者：陈昶[1] 朱余明[1] 姜格宁[1] 王海峰[1] 谢冬[1] 苏杭 徐龙 赵德平[1] 段亮[1] 谢博雄[1] 武春燕[2] 侯立坤[2] 谢惠康[2] 范军强[3] 张雪冬 施伟荣 柯宏刚[5] 张雷[1] 汪浩[1] 胡学飞[1] 陈乾坤[1] 蒋雷[1] 何文新[1] 周逸鸣[1] 秦雄 赵晓刚[1] 刘鸿程[1] 张鹏[1] 杨洋[1] 刘明[1] 郑卉[1] CHEN Chang;ZHU Yuming;JIANG Gening;WANG Haifeng;XIE Dong;SU Hang;XU Long;ZHAO Deping;DUAN Liang;XIE Boxiong;WU Chunyan;HOU Likun;XIE Huikang;FAN Junqiang;ZHANG Xuedong;SHI Weirong;KE Honggang;ZHANG Lei;WANG Hao;HU Xuefei;CHEN Qiankun;JIANG Lei;HE Wenxin;ZHOU Yiming;QIN Xiong;ZHAO Xiaogang;LIU Hongcheng;ZHANG Peng;YANG Yang;LIU Ming;ZHENG Hui(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University School of Medicine,Shanghai,200433,P.R.China;Department of Pathology,Shanghai Pulmonary Hospital,Tongji University School of Medicine,Shanghai,200433,P.R.China;Department of Thoracic Surgery,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,310009,P.R.China;Department of Thoracic Surgery,The Sixth People’s Hospital of Nantong,Shanghai University,Nantong,216002,Jiangsu,P.R.China;Department of Cardiothoracic Surgery,Affiliated Hospital of Nantong University,Nantong,226001,Jiangsu,P.R.China)

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200433 [2]同济大学附属上海市肺科医院病理科,上海200433 [3]浙江大学医学院附属第二医院胸外科,杭州310009 [4]南通市第六人民医院(上海大学附属南通医院)胸外科,江苏南通216002 [5]南通大学附属医院心胸外科,江苏南通226001

出　　处：《中国胸心血管外科临床杂志》2021年第11期1292-1298,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较肺段切除术和肺叶切除术在直径≤2 cm且术中冰冻证实微乳头和实性亚型阴性肺腺癌中的治疗效果。方法纳入2020年6月至2021年3月多中心行肺段切除术或肺叶切除术的234例肺腺癌患者。根据随机数字表法将患者分为两组:肺段切除组(段切组)119例,男44例、女75例,年龄(56.6±8.9)岁,肺叶切除组(叶切组)115例,男43例、女72例,年龄(56.2±9.5)岁。比较两组患者临床资料。结果两组患者术前基线资料差异无统计学意义(P>0.05)。两组患者均无围术期死亡病例。两组患者在手术时间[(111.2±30.0)min vs.(107.3±34.3)min]、术中失血量[(54.2±83.5)mL vs.(40.0±16.4)mL]、引流管拔管时间[(2.8±0.6)d vs.(2.6±0.6)d]、住院时间[(3.9±2.3)d vs.(3.7±1.1)d]和病理分期方面差异均无统计学意义(P>0.05)。段切组患者术前和术后半年用力肺活量与一秒用力呼气容积占预计值的百分比差值显著优于叶切组患者[(0.2±0.3)L vs.(0.4±0.3)L,P=0.005,0.3%±8.1%vs.2.9%±7.4%,P=0.041]。结论肺段切除术可有效保护患者肺功能,有望改善患者术后生活质量。Objective To compare the clinical effects of segmentectomy and lobectomy for ≤2 cm lung adenocarcinoma with micropapillary and solid subtype negative by intraoperative frozen sections. Methods The patients with adenocarcinoma who received segmentectomy or lobectomy in multicenter from June 2020 to March 2021 were included. They were divided into two groups according to a random number table, including a segmentectomy group(n=119, 44 males and 75 females with an average age of 56.6±8.9 years) and a lobectomy group(n=115, 43 males and 72 females with an average of 56.2±9.5 years). The clinical data of the patients were analyzed. Results There was no significant difference in the baseline data between the two groups(P>0.05). No perioperative death was found. There was no statistical difference in the operation time(111.2±30.0 min vs. 107.3±34.3 min), blood loss(54.2±83.5 mL vs. 40.0±16.4 mL), drainage duration(2.8±0.6 d vs. 2.6±0.6 d), hospital stay time(3.9±2.3 d vs. 3.7±1.1 d) or pathology staging(P>0.05)between the two groups. The postoperative pulmonary function analysis revealed that the mean decreased values of forced vital capacity and forced expiratory volume in one second percent predicted in the segmentectomy group were significantly better than those in the lobectomy group(0.2±0.3 L vs. 0.4±0.3 L, P=0.005;0.3%±8.1% vs. 2.9%±7.4%,P=0.041). Conclusion Segmentectomy is effective in protecting lungs function, which is expected to improve life quality of patients.

关 键 词：肺段切除术 肺叶切除术 微乳头 实性 肺腺癌 随机对照试验 

分 类 号：R734.2[医药卫生—肿瘤]