非小细胞肺癌肺叶袖状切除术手术安全性及远期疗效分析

Safety and long-term outcome of sleeve lobectomy for non-small cell lung cancer

背景与目的:长期以来,全肺切除术是治疗非小细胞肺癌的常用术式,仅少部分有适应证的肺癌患者选用肺叶袖状切除术。本研究评价肺叶袖状切除术在非小细胞肺癌治疗中的价值。方法:中山大学肿瘤防治中心1997年1月至2007年12月共施行非小细胞肺癌根治性袖状切除术93例,同期施行根治性全肺切除术571例。将两种手术方式的术后并发症发生率及术后死亡率进行比较,并回顾性分析两种手术方式的5年生存率。结果:袖状切除术术后并发症发生率为11.8%,全肺切除术术后并发症为20.7%,两组间差异有统计学意义(P=0.046)。术后死亡率袖状切除术组为2.1%,全肺切除术组为4.7%,两组间差异无统计学意义(P=0.259)。袖状切除术和全肺切除术术后5年生存率分别为42.0%、31.5%,组间差异有统计学意义(P=0.015);其中N0、N1患者5年生存率袖状切除术组优于全肺切除术组(P=0.007,P=0.025),N2患者5年生存率两组间差异无统计学意义(P=0.073)。支气管肺动脉双袖状切除术与全肺切除术组间5年生存率差异无统计学意义(P=0.092)。袖状切除术组与全肺切除术组之间的术后局部复发率差异无统计学意义(P=0.821)。结论:非小细胞肺癌袖状切除术手术安全性及远期疗效均优于全肺切除术,值得在临床上推广应用。

Background and Objective. Pneumonectomy has been long term used as the standard surgical procedure for central type non-small cell lung cancer （NSCLC）. Sleeve Iobectomy has been performed in a small number of patients meeting the indications. This study was to compare the 5-year survival rate, operation related complications and mortality of sleeve Iobectomy with pneumonectomy for NSCLC, and evaluate sleeve Iobectomy in the surgical treatment for NSCLC. Methods. Ninety-three patients with NSCLC undergoing sleeve Iobectomy （group A） and 571 patients with NSCLC undergoing pneumonectomy （group B） from January 1997 to December 2007 in Sun Yat-sen University Cancer Center were reviewed. The 5-year survival rate, operation related complications and mortality between the two groups were analyzed. Results. The overall 5-year survival for group A and group B were 42.0% and 31.5%, respectively （P=0.015）. In the subgroup analysis, the 5-year survival of NO （P=0.007） and N1 （P=0.025） patients were significant higher in group A than in group B, while the survival were not significantly different between N2 patients （P=0.073）. The 5-year survival rates for bronchial and pulmonary arterial sleeve resection （the subset of group A） and pneumonectomy were not significantly different （P=0.092）. There was no significant difference in local recurrences between the groups （P=0.821）. The postoperative complication rates were 11.8% in group A and 20.7% in group B （P=0.046）. There was no statistically significant difference in mortality between the two groups （P=0.259）. Conclusion. The operative safety and long term efficacy of sleeve Iobectomy are superior to pneumonectomy for NSCLC.