胸腔镜辅助小切口肺癌根治术对非小细胞肺癌患者淋巴结清扫及远期疗效评价

Video-assisted Minithoracotomy for Lymph Node Dissection and the Long-term Efficacy for Patients with Non-small Cell Lung Cancer

目的探讨胸腔镜辅助小切口肺癌根治术对非小细胞肺癌的疗效。方法选择2008年4月至2010年11月在冀中能源邢台矿业集团有限责任公司总医院住院治疗的非小细胞肺癌患者48例作为研究对象,依据随机数字表法分为胸腔镜组和开放组,各24例。胸腔镜组采用胸腔镜下肺癌切除术,开放组行传统开胸手术。比较两组患者手术一般情况、疼痛程度、免疫炎症指标,并记录两组患者远期生存率。结果胸腔镜组术中出血量、置管时间、住院时间均显著低于开放组[(166±36)m L比(270±53)m L,(4.8±1.5)d比(6.5±2.1)d,(6.5±2.3)d比(9.6±3.7)d],差异有统计学意义(P<0.01)。术后1 d、3 d胸腔镜组疼痛评分显著低于开放组(P<0.05);术后1周胸腔镜组C反应蛋白、白细胞计数、中性粒细胞比值均显著低于开放组,自然杀伤细胞、Ig A、Ig G、Ig M显著高于开放组(P<0.01)。对患者进行3年随访,两组患者1、2、3年生存率相比差异均无统计学意义(P>0.05)。结论胸腔镜辅助小切口肺叶切除术与传统开胸手术具有相近的远期疗效,且安全性高,对机体损伤更小,可作为非小细胞肺癌手术治疗的方法之一。

Objective To explore the effect of video-assisted minithoracotomy in patients with non-small cell lung cancer（NSCLC）. Methods A total of 48 NSCLC patients admitted to Jizhong Energy Xingtai MIG General Hospital from Apr. 2008 to Nov. 2010 were randomly divided into thoracoscopy group of 24 cases and open group of 24 cases, thoracoscopy group received thoracoscopic lung resection, the open group underwent conventional open chest operation. The general operation situation, pain degree, inflammatory and immune index of the two groups were compared, and long-term survival rate of the two groups were recorded. Results The bleeding volume, indwelling time, hospitalization time of the thoracoscopy group were significantly lower than those of the open group[（166±36） mLvs （270±53） mL,（4.8±1.5） d vs （6.5±2.1） d, （ 6.5±2.3 ） d vs （9. 6±3.7 ） d ] （ P 〈 0. 01 ）. After 1 d,3 d pain score in the thoraeoseopy group was sig- nificantly lower than that of the open group（ P 〈 0. 05 ） , after one week, C-reactive protein, white blood cell count, neutrophils ratio in the thoracoscopy group were significantly lower than the open group, NK cell, IgA, IgG,IgM were significantly higher than the open group （P 〈 0. 01 ）. The patients were followed up for 3 years, and the 1 year, 2 years, 3 years survival rate had no statistically significant difference （P 〉 0.05 ）. Conclusion Video-assisted minithoracotomy lobectomia pulmonalis has high safety,less injury to the body, can be used as one of operative treatments for non-small cell lung cancer.