胸腔镜与开胸肺叶切除术治疗老年非小细胞肺癌的比较

Comparative clinical study of the effects of video-assisted thoracic lobectomy and thoracotomy lobectomy treatment on the elderly patients with non-small cell lung cancer

目的 观察并比较胸腔镜和开胸肺叶切除术治疗老年非小细胞肺癌（non-small cell lung cancer,NSCLC）的临床疗效,为合理选择治疗方案提供依据.方法 40例老年NSCLC患者,其中全胸腔镜肺叶切除术治疗20例（观察组）,开胸肺叶切除术治疗20例（对照组）,回顾性观察与对比分析两组手术切口长度、手术时间、手术出血量、淋巴结清扫数量、术后胸引流总量、术后疼痛程度、住院时间以及并发症等指标.结果 观察组平均手术切口长度、手术出血量、术后疼痛程度、术后胸引流总量、住院时间以及并发症发生率均明显低于对照组[（6.6±0.9） cm vs （21.8±3.2） cm,P＜0.01;（115±16） mL vs （173±24） mL,P＜0.01;（4.2±0.6）分vs（7.9±1.1）分,P＜0.05;（598±83） mLvs （832±116） mL,P＜0.01; （12±2）d vs（16±3）d,P＜0.05; （10％ vs30％,P＜0.01）].两组平均手术时间[（179±25） minvs （182±26） min,P＞0.05]和淋巴结清扫数量[（15.3±2.2）枚/例vs（14.8±2.1）枚/例,P＞0.05]比较,差异无统计学意义.结论 与传统的开胸肺叶切除术比较,胸腔镜肺叶切除术治疗老年NSCLC有明显优势,值得在临床上推广应用.

Objective To comparatively observe the effects of video-assisted thoracic lobectomy and thoracotomy lobectomy treatment on the elderly patients with non-small cell lung cancer （NSCLC） in order to determine the appropriate treatment of elderly NSCLC. Methods 40 elderly patients with NSCLC, including 20 cases （observation group） with the treatment of video-assisted thoracic lobectomy and 20 cases （control group） with the treatment of thoracotomy lobectomy, were retrospectively analyzed and compared. The levels of the changes in the length of the incision, operation time, blood loss, number of lymph node dissection, the total postoperative chest drainage, postoperative pain, hospital stay and complication rates were assessed and compared, respectively. Results The average index value incision length, blood loss, postoperative pain scores, total postoperative chest drainage, length of hospital stay and complication rates of obs ervationgroup were significantly lower than the control group [（6.6±0.9 ） cm vs （21.8±3.2） cm, P〈0.01; （115±16） mL vs （173±24）mL, P〈0.01; （4.2±0.6） 分vs （7.9±1.1） 分, P〈0.05; （598±83）mL vs （832±116） mL, P〈0.01; （12±2） d vs （16±3） d, P〈0.05; （ 10% vs30%, P〈0.01]. The differences of the mean operative time [（179±25） min vs （ 182±26 ） rain, P〉0.05] and the number of lymph node dissection [（ 15.3±2.2 ） pieces / case vs （ 14.8±2.1 ） pieces / case, P〉0.05] in the two groups were not statistically significant. Conclusion In the treatment of elderly patients with NSCLC, compared with the traditional thoracotomy lobectomy, thoracoscopic lobectomy has obvious advantages and is worthy of clinical application.