电视胸腔镜微创手术与常规肺癌手术淋巴结清扫的对照研究

The Comparative Study of Lymph Node Dissection by Video-assisted Thoracoscopic Surgery (VATS) and Conventional Lateral Incision Surgery

背景与目的通过比较电视胸腔镜(video-assisted thoracoscopic surgery,VATS)肺癌根治手术与常规后外侧切口下的肺癌根治手术的淋巴结清扫情况,评价VATS肺癌根治术中淋巴结清扫的效果。方法将100例术前临床诊断为围型肺癌患者随机分为腔镜手术组和常规开胸手术组,分别进行VATS微创根治性肺癌切除、淋巴结清扫手术和传统后外侧切口根治性肺癌切除、淋巴结清扫手术,分别统计两组清除淋巴结总数及阳性淋巴结数,并进行统计学分析。结果腔镜手术组50例患者均顺利完成根治性手术,清扫N1淋巴结242个,N2淋巴结232个,N3淋巴结0个,阳性淋巴结数197个;开胸手术组清扫N1淋巴结243个,N2淋巴结238个,N3淋巴结1个,阳性淋巴结数198个,两组淋巴结总数无统计学差异(χ2=0.016,P=0.815),阳性淋巴结数比较也无统计学差异(χ2=0.034,P=0.956)。结论电视胸腔镜微创手术在周围型肺癌患者中可以达到肺癌根治性切除、淋巴结清扫,其淋巴结的清扫数量和阳性淋巴结清除率与常规开胸手术无异。

Background and objective Although widely adopted,there is lack of comparative data for patients undergoing lymph node dissection in radical surgery of lung cancer by video-assisted thoracoscopic surgery（VATS） vs conventional lateral incision surgery. The aim of this study is to compare the effects of lymph node dissection in radical surgery of lung cancer by VATS. Methods One hundred patients with preoperative diagnosis of peripheral lung cancer were assigned to laparoscopic surgery group（VATS） and conventional surgery group（TH） randomly. The number of removed lymph nodes and rate of positive lymph nodes were analyzed statistically. Results The number of removed lymph nodes in VATS group were： N1 242,N2 232,N3 0,197 with positive lymph nodes;conventional surgery group： N1 243,N2 238,N3 1,198 with positive lymph nodes. There was no significant difference for the total number of lymph nodes in two groups（χ2=0.016,P=0.815） ,nor for the number of positive nodese（χ2=0.034,P=0.956） . Conclusion Peripheral lung cancer may get radical resection and lymph node clearance by VATS. There are no significant difference for the number of removed lymph nodes and positive rate of lymph nodes in VATS and conventional surgery.