完全电视胸腔镜肺叶切除术治疗早期肺癌的近期疗效评价

Short-term Clinical Outcomes of Complete Video-assisted Thoracoscopic Lobectomy for Early-stage Lung Cancer

目的 探讨完全电视胸腔镜（VATS）肺叶切除术治疗早期肺癌的可行性、安全性及近期疗效。 方法回顾性分析2012年1月至2013年5月济宁市第一人民医院连续138例早期肺癌施行肺叶切除术患者的临床资料，其中完全电视胸腔镜肺叶切除术组 （VATS组） 71例，男39例，女32例 ；年龄 （57.9±10.6） 岁；传统开胸肺叶切除术组 （开胸组） 67例，男36例，女31例；年龄 （60.3±8.2） 岁。比较两组患者手术时间、术中出血量、清扫淋巴结组数及个数、带胸腔引流管时间、术后住院时间、术后第1 d、3 d、30 d疼痛视觉模拟评分 （vision analogue score，VAS）以及术后并发症发生情况。 结果 两组患者均顺利完成手术。VATS组患者术中出血量 ［（147±113） ml vs. （146±91） ml］、清扫淋巴结个数 ［（9.9±3.6） 枚 vs. （10.0±3.6） 枚］ 及组数 ［（3.1±1.3） 组 vs. （3.4±1.3） 组］、术后第1 d、第3 d VAS评分与开胸组差异无统计学意义（P＞0.05）；VATS组手术时间 ［（119±27） min vs. （135±29） min］、术后带胸腔引流管时间 ［（3.0±0.9） d vs. （3.8±1.2） d］、术后住院时间 ［（8.0±2.1） d vs. （10.2±5.4） d］、术后第30 d VAS评分 ［（2.6±0.7）分vs. （3.2±1.1） 分］ 及术后并发症发生率均短于或少于开胸组（P＜0.05）。VATS组术后随访59例，开胸组术后随访58例，随访时间2～18个月，两组均无死亡，其中脑转移1例，肝转移1例，骨转移2例。 结论对于早期肺癌的治疗，采用完全胸腔镜肺叶切除术安全可行，它具有创伤小、并发症少，术后恢复快、慢性胸痛轻微等优势。同时能够达到与常规开胸手术相同的规范化淋巴结清扫。

Objective To investigate the feasibility,safety and short-term clinical outcomes of complete videoassistedthoracoscopic surgery （VATS） lobectomy for patients with early-stage lung cancer （LC）. Methods Clinical data of 138 consecutive patients with early-stage LC who underwent lobectomy in the First People’s Hospital of Jining from January2012 to May 2013 were retrospectively analyzed. There were 71 patients undergoing complete VATS lobectomy including39 male and 32 female patients with their age of 57.9±10.6 years （VATS group）,and 67 patients undergoing lobectomyvia traditional thoracotomy including 36 male and 31 female patients with their age of 60.3±8.2 years （thoracotomy group）. Operation time,intraoperative blood loss, groups and number of lymph node dissection,thoracic drainage duration,postoperative hospital stay,vision analogue scores （VAS） on the 1st,3rd and 30th postoperative day, and postoperativemorbidity were compared between the 2 groups. Results All the patients in both groups success fully received their opera-tion. Intraoperative blood loss （147±113 ml vs. 146±91 ml）,number of lymph node dissection （9.9±3.6 vs. 10.0±3.6）,group of lymph node dissection （3.1±1.3 vs. 3.4±1.3）,and VAS on the 1st and 3rd postoperative day of VATS group were not statistically different from those of the thoracotomy group （P〉0.05）. Operation time （119±27 minutes vs.135±29 minutes）,thoracic drainage duration （3.0±0.9 days vs. 3.8±1.2 days）,postoperative hospital stay （8.0±2.1 daysvs. 10.2±5.4 days）,VAS on the 30th postoperative day （2.6±0.7 vs. 3.2±1.1） and postoperative morbidity （8.5% vs.19.4%） of VATS group were significantly shorter or lower than those of the thoracotomy group （P〈0.05）. Fifty-nine pati-ents in VATS group and 58 patients in the thoracotomy group were followed up for 2-18 months after disc harge. During follow-up,there was no death in either group. There was 1 patient with brain metastasis,1 patient with liver metastasis,and2 patients with bone metastasis. Conclusion Complete VATS lobectomy is safe and feasible for the treatment of early LC with the advantages of minimal invasiveness,less morbidity,better postoperative recovery and less chronic incision pain. Complete VATS lobectomy can also achieve similar standardization of lymph node dissection as routine thoracotomy.