518例早期肺癌的电视胸腔镜肺叶切除术

Video-assisted thoracic surgery Iobectomy for early lung cancer： retrospective study of 518 cases

目的探讨采用电视胸腔镜手术（VATS）治疗早期肺癌的理论依据和实践规范，分析影响预后的相关因素。方法1997年5月至2009年10月，518例早期肺癌患者行VATS肺叶切除术中男297例，女221例；平均年龄（58．9±10．6）岁。结果术后并发症和手术死亡分别为10．8％和0．4％。患者年龄（P=0．0300，OR=2．0148，95％CI1．0700～3．7940）和手术时间（P=0．0007，OR=1．0086，95％CI1．0036～1．0136）是影响术后并发症发生率的独立危险因素。1、3、5年总生存率为98％、81％、66％，术后病理分期（P=0．0036，OR=1．6071，95％CI1．1677～2．2118）是惟一的影响因素。结论VATS肺叶切除术是治疗早期肺癌的一种安全手术方式。对于高龄患者应慎重；手术时问不宜过长；合理处理意外状况、必要时应果断中转开胸有助于降低手术风险。

Objective The purpose of the present study was to analyses video-assisted thoracic surgery （VATS） lobectomy for early lung cancer and to provide evidence in guiding clinical practice. Methods From May 1997 to October 2009, VATS lobectomy for early lung cancer was performed in 518 patients. All patient data was reviewed retrospectively. Results The data group consisted of 297 male patients and 221 female patients with a mean age of （58.9 ± 10.6） years （ 19 - 89 years）. Morbidity was 10.8% and mortality was 0.4%. Multivariate analysis identified patient＇s age （P = 0. 0300, OR = 2. 0148,95% CI 1. 0700 - 3. 7940） and operation duration （ P = 0. 0007, OR = 1. 0086, 95% CI 1. 0036 - 1. 0136 ） as the statistically significant predictors of postoperative complications. Overall 1, 3 and 5-year survival rates were 98% , 81% and 66%. And postoperative pathological staging （P = 0. 0036, OR = 1. 6071, 95% CI 1. 1677 -2. 2118） is a prognostic determinant. Conclusion VATS lobectomy is a safe and effective therapeutic method for early lung cancer. However, patient selection plays key role in VATS. Operation duration should be shortened as possible, otherwise, it may result in increased post- operative morbidity. It is important to deal with the accident situation rationally and converse to thoracotomy decidedly if necessary.