1131例单中心全胸腔镜肺叶切除治疗非小细胞肺癌的远期疗效

Long-term outcome of thoracoscopic lobectomy for non-small cell lung cancer： series of consecutive 1131 patients in single center

目的 总结单中心非小细胞肺癌接受全胸腔镜肺叶切除患者资料,分析远期疗效.方法 2006年9月至2014年4月北京大学人民医院胸外科连续完成1 131例非小细胞肺癌患者的全胸腔镜肺叶切除术.男594例,女537例;年龄29～ 86岁,平均（61.5±10.7）岁.手术均为全胸腔镜下解剖性肺叶切除加系统性淋巴结清扫,其中肺叶切除1 075例,复合肺叶切除23例,袖式肺叶切除20例,全肺切除12例,双侧同期行肺叶切除手术1例.统计分析患者围手术期、病理资料和随访资料.结果 全组完成全胸腔镜手术1 045例,中转开胸87例（7.7％）.手术时间70～ 430 min,中位时间180 min;术中出血量10～3 100 ml,中位值100 ml.术后带胸管（6.4±3.7）天;术后平均住院（8.8±4.6）天.术后并发症154例（13.6％）,围手术期死亡7例（0.6％）.术后病理：腺癌909例（80.4％）,其中原位腺癌（肺泡细胞癌）55例（4.9％）;鳞癌181例（16.0％）;腺鳞癌17例（1.5％）;大细胞癌14例（1.2％）;组织分型困难10例（0.9％）.全组1、3、5年无瘤生存率分别为91.5％、77.5％、76.4％,1、3、5年总生存率分别为96.0％、85.4％、76.4％.结论 全胸腔肺叶切除手术用于治疗可切除非小细胞肺癌是一种安全有效的微创手术方式,总体近、远期效果理想优于既往开胸报道.

Objective To summarize the experience of completely thoracoscopic lobectomy for non-small-cell lung cancer（NSCLC） in a single center and to evaluate the long-term outcome.Methods The data of 1 131 NSCLC patients who received completely thoracoscopic lobectomy in Peking University People＇s Hospital between September 2006 and April 2011 were retrospectively reviewed.594 males and 537 females with an average age of 61.5 years old were included.Completely thoracoscopic lobectomy and systematic lymph node dissection were performed,including lobectomy in 1 075 cases,bilobectomy in 23 and sleeve lobectomy in 20,pneumectomy in 12,and bilateral lobectomy in 1.Results 1 045 of all 1 131 cases finished completely thoracoscopic anatomic lobectomy,the other 87 cases converted to thoracotomy with a conversion rate of 7.7%.The median surgical duration was 180 min,and median intraoperative blood loss was 100 ml.The average chest tube duration was 6.4 days,and average postoperative hospital stay was 8.8 days.Postoperative complications were reported in 154 cases （13.6%）,and death were reported in 7 patients during perioperative period with a perioperative mortality of 0.6%.Pathology：909 （80.4%） adenocarcinomas including 55 （4.9%） adenocarcinomas in situ,181 （16.0%） squamous carcinomas,17 （1.5%） adenosquamous carcinomas,14（1.2%） large cell carcinomas,10（0.9%） NOS.The 1-year,3-year and 5-year DFS survival rates were 91.5%,77.5% and 76.4% respectively.The 1-year,3-year and 5-year overall survival rates were 96.0%,85.4% and 76.4% respectively.Conclusion Completely thoracoscopic lobectomy was a safe and effective mini-invasive procedure for resectable NSCLC.Its long-term outcome was remarkable.