电视胸腔镜辅助小切口与开胸手术治疗原发性非小细胞肺癌的疗效对比

Effect comparison between video-assisted mini-thoracotomy and thoracotomy in the treatment of patients with non-small cell lung cancer

目的比较电视胸腔镜辅助小切口(VAMT)与开胸手术治疗原发性非小细胞肺癌(NSCLC)的临床疗效。方法选取NSCLC行手术治疗患者92例为研究对象,根据手术方式不同分为VAMT组48例和开胸手术组42例。2组均行肺叶切除加常规淋巴结清扫。对比2组手术相关资料,术后随访,记录并发症发生情况,运用QLQ-LC43量表评价2组术后生活质量,并行Kaplan-Meier生存分析。结果 VAMT组术中出血量、术后72 h引流量显著低于开胸手术组,置管留置时间和术后住院时间显著短于开胸手术组(P<0.05或P<0.01);2组淋巴结清扫数量差异无统计学意义(P>0.05);VAMT组术后并发症发生率显著低于开胸手术组(6.3%vs.20.5%,P<0.05);VAMT组术后1、3个月QLQ-LC43评分显著高于开胸手术组(P<0.01);VAMT组和开胸手术组生存期分别为35.9个月、34.4个月,无进展生存期分别为31.9个月、29.2个月,差异无统计学意义(P>0.05)。结论 VAMT治疗NSCLC具有良好的近/远期疗效,与传统开胸手术相比,患者创伤小,且术后恢复时间短。

Objective To compare the clinical efficacy of video-assisted mini-thoracotomy（ VAMT） and thoracotomy in the treatment of patients with non-small cell lung cancer（ NSCLC）.Methods Ninety-two patients NSCLC with surgical treatment were selected as research objects,and were divided into VAMT group（ n = 48） and thoracotomy group（ n = 42） according to different surgical methods. Both groups were given pulmonary lobectomy plus routine lymphadenectomy. Surgeryrelated data were compared,postoperative follow-up was conducted,and the occurrence of complications was recorded in both groups. The postoperative quality of life was assessed by QLQ-LC43 scale,and Kaplan-Meier survival analysis was performed. Results The intra-operative amount of bleeding and postoperative 72 h drainage volume were less,and time of indwelling catheter and postoperative hospital stay were significantly shorter in VAMT group than thoracotomy group（ P〈 0. 05 or P 〈0. 01）. There was no significant difference between two groups in the number of lymphadenectomy（ P〉 0. 05）. The incidence rate of postoperative complications in VAMT group was significantly lower than thoracotomy group（ P〈 0. 05）. The QLQ-LC43 scores in VAMT group were significantly higher than those in thoracotomy group 1 and 3 months after surgery（ P〈 0. 01）. The survival time of VAMTgroup and thoracotomygroup were 35. 9 and 34. 4 months,progression-free survival were 31. 9and 2 9. 2 months,and there were no significant differences（ P〉 0. 0 5）. Conclusion VAMT has better recent and long-term efficacy in the treatment of NSCLC. Compared with thoracotomy,it has advantages of small trauma and postoperative recovery.