胸腔镜结扎肿瘤滋养血管加化疗在Ⅲ、Ⅳ期肺癌中的效果评价

Effect evaluation of the thoracoscopic ligation of tumor feeding vessels combined with chemotherapy in the treatment of lung cancer in the stage Ⅲ and Ⅳ

目的探讨胸腔镜下结扎肿瘤滋养血管加化疗治疗Ⅲ、Ⅳ期肺癌的效果。方法回顾性分析2008年1月～2010年9月南方医科大学附属江门医院胸外科和肿瘤科116例Ⅲ、Ⅳ期非小细胞肺癌（NSCLC）患者的治疗方法及效果，分为结扎血管组42例及未结扎血管组74例，结扎血管组给予术中结扎肿瘤滋养的血管，术后化疗：未结扎血管组术中未结扎肿瘤滋养血管或者未行手术，给予单纯化疗。比较两组化疗前、后肺部原发灶缩小情况及1、3生存率。结果结扎血管组在第1次化疗前、后复查肺癌原发灶缩小分别为22例（52．4％）、38例（90．5％），未结扎血管组在第1次化疗前、后复查肺癌原发灶缩小分别为0例（0．0％）、55例（74．3％），结扎组高于未结扎组，差异有统计学意义（P〈0．05）。结扎血管组1、3年生存率分别为61．9％、21．4％，未结扎血管组1、3年生存率分别为41．9％、18．9％，1年生存率两组比较，差异有统计学意义（P〈0．05），3年生存率两组比较，差异无统计学意义（P=0．745）。结论结扎肿瘤滋养的血管加化疗的治疗Ⅲ、Ⅳ肺癌，与单纯化疗相比能提高近期疗效（1年生存率），特别是原发灶缩小效果明显，但远期疗效尚要观察，最佳的治疗模式还需要进一步探讨。

Objective To study the effect of the thoracoscopic ligation of tumor feeding vessels combined with chemotherapy in the treatment of lung cancer in the stage ⅢandⅣ. Methods Retrospective analysis of the effect of treatment for 116 patients with non-small cell lung cancer （NSCLC） in the stage Ⅲ orⅣ in the Department of Tho- racic Surgery and Department of Oneology in Affiliated Jiangmen Hospital of Southern Medical University from January 2008 to September 2010 were selected and divided into 2 groups. 42 patients in vessels ligation group were performed with the thoracoscopie ligation of tumor nourishing vessels combined with postoperative chemotherapy. 74 patients in non-ligature vessels group were performed with tboracoscopic surgery without the ligation of tumor nourishing vessels or only simple chemotherapy without surgery. Pulmonary primary tumors shrink before and after chemotherapy and 1, 3 years survival rate were compared in the two groups. Results In the vessels ligation group, the regression of the primary tumor before the first time chemotherapy were 22 cases （52.4%）,after the first time chemotherapy were 38 cases （90.5%）; in non-ligature vessels group,the regression of the primary tumor before the first time chemotherapy were 0 case （0.0%）,after the first time chemotherapy were 55 cases （74.3%）, the differences between the two groups were sta- tistically significant （P 〈 0.05）. In the vessels ligation group, 1, 3 year survival rate were 61.9%, 21.4% respectively; in non-ligature vessels group, 1, 3 year survival rate were 41.9%, 18.9% respectively, the difference of 1 year survival rate between the two groups was statistically significant （P 〈 0.05）; the difference of 3 years survival rate between the two groups was not statistically significant （P 〉 0.05）. Conclusion Compared with simple chemotherapy,the ligation of tumor feeding vessels combined with chemotherapy can improve the curative effect of lung cancer in the stage Ⅲ orⅣ in the near future （1 year survival rate）, especially the effect of reduction of the primary tumor is obvious, but the long-term effect still need to be observed, the best mode of treatment of lung cancer in the stage Ⅲ orⅣneed to be further investigated.