非小细胞肺癌患者行胸腔镜下手术治疗的围术期状况及远期生存状况研究

Perioperative conditions and long-term survival of patients with non-small cell lung cancer after thoracoscopic lobectomy

目的：分析非小细胞肺癌（NSCLC）患者行胸腔镜肺叶切除术治疗后的围术期状况及远期生存状况。方法选取2006年1月-2012年12月该院收治的行胸腔镜下肺叶切除术的119例 NSCLC 患者为研究对象。统计分析其围手术期指标、病理结果及随访资料。结果全部患者中9例（7.0%）患者中转开胸，中位手术时间、中位术中出血量、开始下床活动时间分别为170 min（65～440 min）、90 ml（15～3000 ml）、（32.9±16.3）h，术后引流时间、引流总量和住院时间分别为（6.7±3.2）d、（1690.0±410.5）ml 和（9.2±4.0）d。围手术期死亡率为0.8%，术后并发症发生率为13.4%，术后病理类型：腺癌96例，鳞癌19例，腺鳞癌2例，大细胞癌2例。出院患者的中位随访时间为34.5个月（0～102个月），局部复发率和远处转移率分别为5.0%和17.6%。患者的1年总体生存率（OS）和无瘤生存率（DFS）分别为85.3%和79.5%，3年 OS 和 DFS 分别为69.8%和64.8%，5年 OS 和 DFS 分别为60.8%和58.6%。各分期患者的复发转移结果比较，差异有统计学意义（P〈0.05）。除了Ⅲ a、Ⅲ b 及Ⅳ期的 OS 和 DFS 略低外，其他分期的总体生存状况相近。结论胸腔镜下肺叶切除手术对 NSCLC 患者的远期疗效较理想，是一个安全有效的术式，值得临床推广应用。

Objective To analyze the perioperative conditions and long-term survival of patients with non-small cell lung cancer （NSCLC） after thoracoscopic lobectomy. Methods 119 patients with NSCLC underwent thoracoscopic lobectomy from January 2006 to December 2012 were enrolled in the study, then collecting and analyzing their perioperative indicators, pathological results and follow-up data. Results 9 patients converted to thoracotomy with a conversion rate of 7.0 %. The median operation time, the median intraoperative blood loss and off-bed activity time were 170 min （65~440 min）, 90 ml （15~3 000 ml） and （32.9 ± 16.3） h after operation respectively. The time and amount of postoperative drainage, the length of hospital stay were （6.7 ± 3.2） d, （1 690.0 ± 410.5） ml, （9.2 ± 4.0） d respectively. The incidence of perioperative mortality and postoperative complications were 0.8 %, 13.4 % respectively. For postoperative pathological type, 96 cases of adenocarcinoma, 19 cases of squamous carcinoma, 2 cases of adenosquamous carcinoma and 2 cases of large cell carcinoma. For discharge patients, the median follow-up time was 34.5 months （0 ~ 102 months）. The incidence of local recurrence and distant metastasis in observation group were 5.0 % and 17.6 % respectively. 1-year overall survival （OS） and disease free survival （DFS） were 85.3 % and 79.5 %, 3-year OS and DFS were 69.8 % and 64.8 %, 5-year OS and DFS were 60.8 %and 58.6 % respectively. There was no significant difference in 1-year, 3-year and 5-year OS and DFS between adenocarcinoma and squamous carcinoma （P〉0.05） while there were significant difference in local recurrence and distant metastasis among different stages （P〈0.05）. In addition to slightly low OS, DFS of Ⅲ a , Ⅲ b and Ⅳ DFS and OS, the overall living conditions among all stage were similar. Conclusions The long-term survival condition of thoracoscopic lobectomy for NSCLC is ideal, and it’s a safe and effective operation, worthy of clinical promoting.