VATS下解剖性亚肺叶切除术联合纵隔淋巴结清扫术治疗早期NSCLC的远期生存率分析  

Long-term Survival Rate of VATS Based Anatomical Sub-lobectomy Combined with Mediastinal Lymph Node Dissection in the Treatment of Early NSCLC

作　　者：秦伟[1] 王永革[1] 林涛 QIN Wei;WANG Yongge;LIN Tao(Anyang People's Hospital,Anyang,455000)

机构地区：[1]河南省安阳市人民医院,455000

出　　处：《实用癌症杂志》2022年第11期1833-1837,共5页The Practical Journal of Cancer

摘　　要：目的探讨电视胸腔镜(VATS)下解剖性亚肺叶切除术联合纵隔淋巴结清扫术治疗早期非小细胞癌(NSCLC)的远期生存率。方法研究选取102例NSCLC患者,根据不同的手术方法将患者分为研究组(n=64)和对照组(n=38)。对照组行传统开胸肺叶切除术联合淋巴结清扫术,研究组行VATS下解剖性亚肺叶切除术联合纵隔淋巴结清扫术,比较两组术中引流管放置时间、手术时间、住院时间、术中失血量、淋巴结清扫数目以及术后疼痛程度,比较两组术前术后肺功能情况、并发症发生情况和远期生存情况。结果通过比较术中和术后情况可知,两组淋巴结清扫数目无明显差异(P>0.05),研究组手术时间、住院时间、引流管放置时间均短于对照组(P<0.05),术中失血量少于对照组(P<0.05),视觉模拟评分(VAS)低于对照组(P<0.05)。两组术前FEV1%、FVC%、MVV%无明显差异(P>0.05),术后两组FEV1%、FVC%、MVV%均下降(P<0.05),且研究组水平均高于对照组(P<0.05)。研究组出现肺不张3例(4.69%)、皮下气肿2例(3.13%),慢性疼痛1例(1.56%);对照组出现切口感染3例(7.89%),肺不张4例(10.53%)、支气管胸膜瘘1例(2.63%),皮下气肿4例(10.53%),慢性疼痛2例(5.26%)。研究组并发症发生率为9.38%,低于对照组(36.84%)(P<0.05)。通过为期3年的随访了解到,研究组术后1年内生存率为87.80%,2年内生存率为76.56%,3年内生存率为71.88%,对照组生存率分别为78.95%、68.42%、52.63%。可知两组1年、2年生存率无明显差异(P>0.05),研究组3年生存率高于对照组(P<0.05)。结论对早期NSCLC患者行VATS下亚肺叶切除术联合淋巴结清扫术,具有手术时间较短、创伤较小、失血量较少、疼痛相对轻微等优势,同时该术式会减少术后并发症的发生,有利于术后肺功能的恢复,可以提高远期生存率。Objective To investigate the long-term survival rate of video-assisted thoracoscopic(VATS)based anatomical sub-lobectomy combined with mediastinal lymph node dissection in the treatment of early non-small cell lung cancer(NSCLC).Methods A total of 102 patients with NSCLC were selected and divided into the study group(n=64)and the control group(n=38)according to different surgical methods.The control group was treated with traditional thoracotomy lobectomy combined with lymph node dissection,and the research group was treated with anatomical sublobar lobectomy combined with mediastinal lymph node dissection under VATS.The placement time of drainage tube,operation time,hospitalization time,intraoperative blood loss,number of lymph node dissections and postoperative pain of the two groups were compared,and the preoperative and postoperative pulmonary function,complication rate and long-term survival of the 2 groups were compared.Results The number of dissected lymph nodes demonstrated no significant difference between the 2 groups(P>0.05).The operation time,hospital stay length,and drainage tube placement time were significantly shorter in the study group than in the control group(P<0.05).The study group had significantly less intraoperative blood loss and lower Visual Analogue Scale(VAS)score compared with the control group(all P<0.05).The forced expiratory volume in one second(FEV1%),forced vital capacity(FVC%),maximal voluntary ventilation(MVV%)displayed no significant difference between the 2 groups at the baseline(P>0.05).After treatment,FEV1%,FVC%and MVV%were significantly decreased in both groups(P<0.05),while the values of three indexes were significantly higher in the study group than in the control group(P<0.05).In the study group,there were 3 cases of atelectasis(4.69%),2 cases of subcutaneous emphysema(3.13%),and 1 case of chronic pain(1.56%).In the control gro-up,there were 3 cases of incision infection(7.89%),4 cases of atelectasis(10.53%),1 case of bronchopleural fistula(2.63%),4 cases of subcutaneous

关 键 词：非小细胞癌 亚肺叶切除术 电视胸腔镜 纵隔淋巴结清扫术 并发症 

分 类 号：R734.2[医药卫生—肿瘤]