电视胸腔镜辅助胸壁小切口与开胸肺癌根治术比较

Comparison of Thoracoscopy-assisted Mini-incision and Traditional Open Surgery for Lung Cancer

目的探讨电视胸腔镜辅助胸壁小切口肺癌根治术的临床效果。方法比较2003年1～6月我院36例电视胸腔镜辅助胸壁小切口行肺癌根治术(胸腔镜组)与30例常规开胸行肺癌根治术(开胸组)手术及生存情况。结果胸腔镜组手术时间(114.6±47.4)min与开胸组(123.3±43.9)min无统计学差异(t=-0.768,P=0.449);胸腔镜组住院时间(9.2±1.4)d明显短于开胸组(10.5±1.7)d(t=-3.408,P=0.001);采用log-rank检验法比较胸腔镜组与开胸组生存曲线无统计学差异(χ2=0.270,P=0.605);COX回归分析显示病理类型(相对危险度3.912,P=0.000)、pTNM分期(相对危险度3.737,P=0.000)及淋巴结转移(相对危险度15.495,P=0.000)是影响非小细胞肺癌术后生存的危险因素,选用何种手术切口与预后无关(P=0.414)。结论电视胸腔镜辅助胸壁小切口肺癌根治术安全、可靠,可取得满意疗效。

Objective To evaluate the outcomes of thoracoseopy-assisted mini-incision procedure in patients with lung cancer. Methods From January 2003 to June 2003, 66 patients with non-small cell lung cancer were treated in our hospital by lobectomy combined with mediastinal lymph node resection using thoraeoscopy-assisted mini-incision （36 patients, VATS Group） or traditional surgery （ 30 patients, traditional group）. The clinical and follow-up data of the two groups were compared after the operation. Results No significant difference was found in the operation time between the VATS and traditional groups[ （114.6± 47.4） rain vs （123.3 ± 43.9 ） rain, t = -0. 768, P = 0. 449 ] , while the postoperative hospital stay of the VATS group was significantly shorter than that in the traditional group [（9.2±1.4） d vs （10.5 ±1.7） d, t = -3.408, P=0.0011. Log-rank test showed that the survival curve in the two groups was comparable （X^2 = 0. 270, P = 0. 605 ）. Cox regression model indicated that the pathological characteristics （ risk ratio ： 3.912, P = 0. 000） , TN M stage （ risk ratio ： 3. 737, P = 0. 000）, and lymph node metastasis （ risk ratio ： 15. 495, P =0. 000） were independent, unfavorable prognostic factors for the disease; whereas, no relation was detected between the thoracotomy incision and prognosis （P = 0. 414）. Conclusions Thoraeoseopy-assisted mini-incision procedure is a safe and reliable approach for patients with lung cancer with satisfying outcomes.