摘要
目的探讨胸腔镜下肺段切除术治疗60岁以上早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的近期疗效。方法回顾性分析2011年10月~2014年12月我科64例60岁以上ⅠA期NSCLC的临床资料,分别行胸腔镜下肺段切除术(肺段切除组,n=32)和胸腔镜下肺叶切除术(肺叶切除组,n=32),比较2组手术时间、术中出血量、淋巴结清扫数目、术后引流管放置时间、住院时间、围术期并发症和随访情况。结果肺段切除组与肺叶切除组术中出血量中位数分别为100(20~900 ml)、150(50~500 ml)ml,无统计学差异(Z=-1.509,P=0.131);术后并发症发生率分别为6.3%(2/32)、9.4%(3/32),无统计学差异(χ~2=0.000,P=1.000);术后胸腔引流管留置时间分别为(5.4±1.2)、(5.5±1.1)d,无统计学差异(t=0.218,P=0.828);住院时间分别为(6.4±1.2)、(6.5±1.1)d,无统计学差异(t=0.218,P=0.828)。肺段切除组手术时间(136.8±65.2)min,明显短于肺叶切除组(189.2±74.2)min(t=2.999,P=0.004)。肺段切除组淋巴结切除中位数6.5枚(3~45枚),明显少于肺叶切除组中位数12.0枚(4~30枚)(Z=-4.750,P=0.000);肺段切除组切除N1淋巴结中位数3.0枚(2~9枚),明显少于肺叶切除组中位数5.0枚(2~11枚)(Z=-3.294,P=0.001);切除N2淋巴结中位数3.5枚(0~36枚),明显少于肺叶切除组中位数8.5枚(1~29枚)(Z=-4.814,P=0.000)。肺段切除组32例中位随访时间18个月(12~42个月),肺叶切除组32例中位随访时间16个月(12~19个月),均无复发和转移。结论胸腔镜下肺段切除术可以作为60岁以上老年ⅠA期NSCLC的治疗选择,近期效果不差于胸腔镜肺叶切除术。
Objective To evaluate the short-term outcomes of video-assisted thoracoscopic surgery （V A T S ） of segmentectomy in the treatment of pathological stage I A non-small cell lung cancer （NSC LC ） in pa tien ts above sixty years old. Methods Clinical data of 64 patients with pathological stage I A NSCLC who underwent VATS segmentectomy （n, = 3 2 ） and VATS lobectomy （n, = 3 2 ） from June 2011 to December 2014 in our hospital were retrospectively analyzed. The operation time, blood loss, number of dissected lymph nodes （including N1 and N2 ） , chest tube duration, postoperative hospital stay, morbidity of postoperative complications and follow-up after operation were compared between the two groups. Results There were no significant differences in blood loss [ 100 （20 -900） ml vs. 150 （50 - 500） ml, Z- - 1 .5 0 9 , P = 0. 131] , morbidity of postoperative complications [ 6. 3%（ 2/ 32） vs. 9. 4% （3/32） , / = 0. 000, P = 1. 000] , chest tube duration [ （5. 4 ± 1. 2） d vs. （5.5 ± 1. 1） = 0. 218 , P = 0. 828 ] , andpostoperative hospital stay [ （6.4 ± 1.2） d vs. （6. 5 ± 1. 1） d,J =0. 218 ,P = 0. 828 ] between the segmentectomy group and the lobectomy group. The operation time of VATS segmentectomy was significantly shorter than that of VATS lobectomy [ （ 136. 8 ± 65. 2） min vs. （189.2 ±74.2） min, t =2. 9 9 9 , P = 0. 004 ] . The total numb er of d issec ted lymph nodes of VATS segmentectomy was lessthan that of VATS lobectomy [6.5 （ 3 - 45 ） vs. 12 （ 4 - 30 ） , Z - - 4 . 750 , P = 0. 000 ] . There were significant differences in the segmentectomy group and the lobectomy group in the number of N1 lymph nodes [3 （2-9） vs. 5 （ 2 - 1 1 ） , Z = - 3. 2 9 4 , P = 0.001] and N2 lymph nodes [3.5 （0-36） vs. 8.5 （1 -2 9 ） , Z- -4.814, P = 0. 000 ] , respectively. There were no recurrence and metastasis during follow-ups for 12 -42 months （ med
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第1期15-18,共4页
Chinese Journal of Minimally Invasive Surgery
基金
北京市自然科学基金(项目编号:7132106)
北京市科委重大项目(项目编号:D141100000214002)
