非小细胞肺癌新辅助治疗后开胸与胸腔镜围手术期疗效的回顾性队列研究  

Perioperative outcomes of video-assisted thoracoscopic surgery versus thoracotomy after neoadjuvant therapy for non-small cell lung cancer:A retrospective cohort study

作　　者：卿阳 滕美新 姚王超 章靖 张鹏[1,2] QING Yang;TENG Meixin;YAO Wangchao;ZHANG Jing;ZHANG Peng(Medical College of Shihezi University,Shihezi,832002,Xinjiang,P.R.China;Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Shanghai,200092,P.R.China;Central Laboratory,Shanghai Pulmonary Hospital,Shanghai,200092,P.R.China)

机构地区：[1]石河子大学医学院,新疆石河子832002 [2]上海市肺科医院胸外科,上海200092 [3]上海市肺科医院中心实验室,上海200092

出　　处：《中国胸心血管外科临床杂志》2025年第4期488-499,共12页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市肺科医院临床研究项目(FKLY20004)。

摘　　要：目的探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)患者新辅助治疗后行电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)和开胸手术的围手术期疗效差异。方法回顾性收集2020年6月—2022年5月上海市肺科医院新辅助治疗后行VATS或开胸手术NSCLC患者的临床资料,比较两组围手术期结果。结果共纳入260例患者,其中184例(70.8%)行VATS,76例(29.2%)行开胸手术。经倾向性评分匹配后VATS组113例(62.4%),开胸组68例(37.6%)。VATS具有与开胸相似的淋巴结清扫能力与术后并发症发生率(P>0.05),优点是手术时间更短(146.00 min vs.165.00 min,P=0.006)、术中失血量更少(50.00 mL vs.100.00 mL,P<0.001)、术中输血率更低(0.0%vs.7.4%,P=0.003)、术后3 d引流量更少(250.00 mL vs.350.00 mL,P=0.011;180.00 mL vs.250.00 mL,P=0.002;150.00 mL vs.235.00 mL,P<0.001)、术后引流时间(9.34 d vs.13.84 d,P<0.001)和术后住院时间(6.19 d vs.7.94 d,P=0.006)更短。结论NSCLC新辅助治疗后行VATS手术安全性高于开胸手术,并且术后恢复更好。Objective To investigate the perioperative differences between video-assisted thoracoscopic surgery(VATS)and thoracotomy after neoadjuvant therapy in patients with non-small cell lung cancer(NSCLC).Methods Clinical data of NSCLC patients who underwent VATS or thoracotomy after neoadjuvant therapy at Shanghai Pulmonary Hospital from June 2020 to May 2022 were retrospectively collected.Perioperative outcomes were compared between the two groups.Results A total of 260 patients were enrolled,184(70.8%)patients underwent VATS and 76(29.2%)patients underwent thoracotomy.After propensity matching,there were 113(62.4%)patients in the VATS group and 68(37.6%)patients in the thoracotomy group.VATS had similar lymph node dissection ability and postoperative complication rate with thoracotomy(P>0.05),with the advantage of having shorter operative time(146.00 min vs.165.00 min,P=0.006),less intraoperative blood loss(50.00 mL vs.100.00 mL,P<0.001),lower intraoperative blood transfusion rate(0.0%vs.7.4%,P=0.003),less 3-day postoperative drainage(250.00 mL vs.350.00 mL,P=0.011;180.00 mL vs.250.00 mL,P=0.002;150.00 mL vs.235.00 mL,P<0.001),and shorter postoperative drainage time(9.34 d vs.13.84 d,P<0.001)and postoperative hospitalization time(6.19 d vs.7.94 d,P=0.006).Conclusion VATS after neoadjuvant therapy for NSCLC is safer than thoracotomy and results in better postoperative recovery.

关 键 词：新辅助治疗 非小细胞肺癌 电视辅助胸腔镜手术 开胸手术 

分 类 号：R734.2[医药卫生—肿瘤]