电视胸腔镜与传统开胸肺叶切除术治疗原发性非小细胞肺癌

Video-assisted Thoracoscopic Lobectomy and Conventional Thoracotomy to Primary Non-small Cell Lung Cancer

目的为了使电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)在临床中得到更好地应用,探讨电视胸腔镜肺叶切除术(VATS lobectomy)治疗原发性非小细胞肺癌(NSCLC)的临床价值。方法2007年9月至2008年12月我科手术治疗NSCLC患者76例,其中37例接受电视胸腔镜肺叶切除术(VATS组),男21例,女16例;平均年龄60.4岁;采用胸腔镜辅助小切口肺叶切除术20例,全胸腔镜肺叶切除术17例。39例接受传统开胸肺叶切除术(传统开胸组),男32例,女7例;平均年龄58.7岁。比较分析两组患者围手术期相关临床和实验室指标的变化。结果两组患者均无严重并发症和围手术期死亡。VATS组与传统开胸组比较,在切口长度(7.6±1.9cmvs.28.5±3.6cm,t=-31.390,P=0.000),术后杜冷丁用量(160±125mgvs.232±101mg,t=-2.789,P=0.007),术后胸腔引流量多于100ml的天数(4.8±2.5dvs.8.1±3.2d,t=-4.944,P=0.000)和术后住院时间(12.1±3.0dvs.15.7±4.7d,t=-3.945,P=0.000)等方面差异有统计学意义;两组在手术时间(t=1.732,P=0.087)、术中出血量(t=-1.645,P=0.105),淋巴结清扫数量(t=-0.088,P=0.930)等方面差异无统计学意义,VATS组的住院总费用略高于传统开胸组,但差异无统计学意义(t=1.303,P=0.197);VATS组术后第1d血糖(7.2±1.2mmol/Lvs.8.4±2.2mmol/L,t=5.603,P=0.000)和白细胞总数(12.7±3.8×109/Lvs.15.1±5.9×109/L,t=5.082,P=0.004)均显著低于传统开胸组,前白蛋白值显著高于传统开胸组(215.0±45.5mg/Lvs.147.3±50.8mg/L,t=-7.931,P=0.000)。结论电视胸腔镜肺叶切除术可彻底清扫淋巴结,术后创伤较小、急性期反应较低、疼痛轻、恢复较快、住院时间短且不明显增加患者经济负担,在严格选择患者的条件下,可以作为治疗早期NSCLC的一种手术途径。

Objective To investigate the clinical value of using video-assisted thoracoscopic lobectomy（VATS lobectomy） to treat primary non-small cell lung cancer（NSCLC） so that the video-assisted thoracoscopic surgery（VATS） can be better used in clinic. Methods From September 2007 to December 2008,seventy-six NSCLC patients were collected. Thirty-seven patients underwent VATS lobectomy（VATS group）,21 male and 16 female with an average age of 60.4 years. Among them 20 underwent video-assisted mini-thoracotomy lobectomy,and 17 underwent total thoracoscopic lobectomy. Thirty-nine patients underwent conventional thoractomy（conventional thoracotomy group）,32 male and 7 female with an average age of 58.7 years. Perioperative clinical and laboratory parameters of the two groups were compared. Results There was no severe complication and perioperative mortality in both groups. There were statistical significances between VATS group and conventional thoracotomy group in incision length （7.6±1.9 cm vs. 28.5±3.6 cm,t=-31.390,P=0.000）,postoperative dosage of dolantin（160±125 mg vs.232±101 mg,t=-2.789,P=0.007）,postoperative chest tube time（chest tube output〉100ml,4.8±2.5 d vs. 8.1±3.2 d,t=-4.944,P=0.000） and postoperative hospitalization time（12.1±3.0 d vs. 15.7±4.7 d,t=-3.945,P=0.000）. There was no statistical significance between two groups in operation time（t=1.732,P=0.087）,intraoperative blood loss（t=-1.645,P=0.105） and the number of lymph node dissection（t=-0.088,P=0.930）. The total hospitalization expenses in VATS group were higher than that in conventional thoracotomy group,but there was no statistical significance（t=1.303,P=0.197）. The serum levels of glucose at 1st day after operation（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L,t=5.603,P=0.000）and the total count of white blood cell （12.7±3.8×10^9/L vs. 15.1±5.9×10^9/L,t=5.082,P=0.004） in VATS group were significantly lower than that in conventional thoracotomy group. The prealbumin（PA） level in VATS group was significantly higher than that in conventional thoracotomy group（215.0±45.5 mg/L vs.147.3＋50.8 mg/L,t=-7.931,P=0.000）. Conclusion VATS lobectomy could clean lymph node completely. Its advantages include less postoperative trauma,lower acute phase response,mild pain,rapid recovery,shorter hospitalization time and less economic burden. It could be an operation approach for early NSCLC patients who have been strictly selected.