电视胸腔镜与开放肺叶切除术治疗非小细胞肺癌的临床结局比较

Clinical Outcomes after Lobectomy for Non-small Cell Lung Cancer by Video-assisted Thoracoscopic Surgery Versus Thoracotomy

目的:比较电视辅助胸腔镜(VATS)与开放肺叶切除术治疗非小细胞肺癌(NSCLC)的临床结局,为外科治疗的术式选择提供依据。方法:回顾性纳入2011年5月到2012年5月我院行肺叶切除术的NSCLC患者,依据手术方式分入VATS(VL)组或开放手术(OL)组,比较两组间基本信息、手术时间、失血量、淋巴结清扫数量、术后并发症、术后住院时间、围术期死亡及远期预后。结果:共纳入符合标准的NSCLC患者285例,其中VL组99例,OL组186例。VL组手术时间(P<0.001)及术后住院时间(P<0.001)显著短于OL组。VL组出血量显著少于OL组(P=0.009),而淋巴结清扫总数(P=0.015)却更多。在术后并发症方面,VL组肺部感染(P=0.040)及伤口并发症(P=0.044)显著少于OL组,其他各类并发症及总并发症率两组并无显著差异。VL组术后1年(P=0.006)和3年生存率(P=0.009)显著优于OL组,但进一步的针对期别的分层分析却并未发现VL组存在生存优势。同时,两组围手术期死亡率并无差异(P=0.774)。结论:相比于传统开放手术,VATS肺叶切除治疗NSCLC疗效可靠,创伤小恢复快,术后并发症少且远期疗效并无劣势。

Objective： To study the clinical outcomes of lobectomy via video-assisted thoracoscopic surgery（VATS） and thoraco- tomy in treatment of non-small cell lung cancer （NSCLC）, which provides the evidence for surgical approach selection. Methods： The pa- tients with NSCLC who underwent lobectomy via VATS or thoracotomy in our center from May 2011 to May 2012 were retrospectively included and divided into VATS lobectomy （VL） or open lobectomy （OL） group according to different operative approach. Their basic data, operating time, blood loss, lymph nodes dissection, postoperative complications, postoperative hospital stay, perioperative mortality and long-term survival were compared. Results： 285 patients with NSCLC were included according to criteria, 99 of whom underwent VATS lobectomy （VL） and 186 of whom underwent open lobectomy （OL）. VL group had a shorter length of operation time （P〈0.001） and postoperative stay （P〈0.001）. The amount of bleeding （P=0.009） in VL group was significantly less than that in OL group, the total number of dissected lymph nodes （P=0.015） in VL group was significantly larger. The incidence of postoperative pulmonary infection （P=0.040） and wound complications （P=0.044） in VL group were significantly lower. However, other postoperative complications rate and total incidence were similar. Patients in VL group had significant longer 1-year （P=0.006） and 3-year survival （P=0.009）. However, further stratified analysis by stage didn＇t show such survival advantages in VL group. Meanwhile, the perioperative mortality of two groups had no statistically significant difference （P=0.774）. Conclusions： VATS lobectomy is reliable and minimally invasive with signif- icantly faster postoperative recovery and less postoperative complications compared with conventional open surgery, which does not compromise oneologic outcomes.