VATS与传统开胸手术对肺癌患者术后短期生存质量影响的对比分析

Life Quality Comparison in Non-small Cell Lung Cancer after Video-assisted Thoracoscopic Surgery versus Standard Posterolateral Thoracotomy

目的:探讨电视辅助胸腔镜肺癌根治术(VATS)与传统后外侧开胸肺癌根治术(SPT)对肺癌患者术后短期生存质量的影响。方法:收集广医附一和附二两院2005年7月-2007年7月的肺癌患者286例进行前瞻性研究。符合入组标准的277例患者按照手术方式随机分为VATS组和SPT组(VATS组154例,SPT组123例);所有患者在入院第1天、以及术后第21天患者出院后复查或者再次入院化疗时使用肺癌患者生存质量量表FACT-L中文版(V4.0)在专业医师、护士的指导下通过自评方式作出评分。对比研究两组患者的生理状况、社会家庭影响、功能状况、情感状况及附加关注情况。结果:两组患者在性别、年龄、术前生存质量等方面差异无统计学意义(P<0.05)。VATS组与SPT组对肺癌患者术后生理状况(17.99±1.50vs17.15±1.50)、情感状况(15.98±1.40vs15.43±1.74)、功能状况(17.17±2.66vs16.52±2.44)、附加关注情况(19.49±2.73vs18.46±3.25)等方面的影响明显较小(P<0.05);对社会家庭状况(15.32±4.93vs14.20±4.89)影响两者相似(P=0.059)。结论:经VATS手术治疗的肺癌患者生存质量明显占优,VATS对患者生理功能等方面的影响较小;适宜手术的肺癌患者行VATS根治术治疗者术后生存质量明显受益。

Objective： To compare the quality of life （QOL） in patients with NSCLC after video-assisted thoracoseopic surgery （VATS） versus standard posterolateral thoracotomy （SPT）. Methods： A prospective randomized controlled trial was conducted among 286 consecutive patients with NSCLC diagnosed between from July 2005 and July 2007. Of these, 277 patients who met inclusion criteria were randomized to receive VATS （VATS group, n=154） or SPT （SPT group, n=123）. Self-reported QOL was assessed using a Chinese version of functional assessment of cancer therapy-lung （FACT-L） in these patients before and on day 21 after the operation, guided by an attending physician or scientific nurse. FACT-L scales of physical welt-being （PW）, emotional well-being （EW）, functional well-being （FW）, social ＆ family well-being （SFW）, as well as lung cancer subscales were compared between the two groups. Results： There were no significant differences between the 2 groups in age, sex and pre-surgical QOL （P〉0.05）. At 21 days after operation. VATS was found to have less impacts on patient-reported scores of PW （17.99±1.50 vs 17.15±1.50）, EW （15.98±1.40 vs 15.43±1.74）, FW （17.17±2.66 vs 16.52±2.44） and lung cancer subscales （19.49±2.73 vs 18.46±3.25） compared with SPT （P〈0.05）, The score of SFW was similar between VATS group and SPT group （15.32±4.93 vs 14.20±4.89） （P=0.059）. Conclusions： Compared with SPT lobectomy, VATS leads to better QOL outcomes and less functional impacts for patients with NSCLC. Indicated candidates may be greatly benefited from VATS.