胸腔镜肺段或肺叶切除术治疗肺磨玻璃结节的比较研究

Comparative Study on Thoracoscopic Anatomic Segmentectomy and Lobectomy for Pulmonary Ground-glass Nodules

目的探讨胸腔镜下解剖性肺段或肺叶切除术诊治肺磨玻璃结节(ground-glass nodule,GGN)的安全性及近期疗效。方法回顾性分析2011年9月~2015年6月我科48例肺段或肺叶切除治疗肺GGN的临床资料,如病灶满足以下条件之一,周围型≤2 cm,为纯磨玻璃结节或CT显示磨玻璃样成分≥50%,CT随诊证实肿瘤倍增时间≥400 d,则行肺段切除术,反之则行肺叶切除术。结果行胸腔镜肺段切除23例,胸腔镜肺叶切除25例。肺段、肺叶切除术手术时间分别为(148.3±25.6)、(110.6±23.1)min(t=5.364,P=0.000),术后住院时间(7.1±1.2)、(9.5±1.7)d(t=-5.605,P=0.000)。术后病理:肺叶切除组恶性23例,良性2例,肺段切除组恶性18例,良性5例。术后1年肺段、肺叶切除术的Karnofsky日常状态评分分别为(93.7±8.5)、(80.3±11.1)分(t=4.665,P=0.000)。41例恶性病例术后随访1~5年,未发现肿瘤复发转移、死亡。结论全胸腔镜解剖性肺段切除治疗肺GGN安全、可行,且术后恢复快,生活质量高。

Objective To evaluate the safety and short-term efficacy of thoracoscopic anatomic segmentectomy and lobectomy for the treatment of pulmonary ground-glass nodules. Methods From September 2011 to June 2015,clinical records of 48 patients with pulmonary ground-glass nodules who underwent thoracoscopic anatomic segmentectomy or thoracoscopic lobectomy were retrospectively reviewed. Segmentectomy was appropriate in selected patients for the following indications： peripheral nodule ≤ 2 cm;pure ground-glass nodule or nodule with ≥ 50% ground glass appearance on CT; radiologic surveillance confirmation of a long doubling time（ ≥ 400 days）. The other patients underwent thoracoscopic lobectomy. Results The thoracoscopic anatomic segmentectomy group contained 23 cases and the thoracoscopic lobectomy group,25 cases. The mean operative time in the thoracoscopic anatomic segmentectomy group was（ 148. 3 ± 25. 6） min and in the thoracoscopic lobectomy group was（ 110. 6 ± 23. 1）min（ t = 5. 364,P = 0. 000）; the postoperative hospitalization time in the thoracoscopic anatomic segmentectomy group was（ 7. 1 ±1. 2） days and in the thoracoscopic lobectomy group was（ 9. 5 ± 1. 7） days（ t =- 5. 605,P = 0. 000）. Postoperative pathological examinations showed that the thoracoscopic lobectomy group contained benign lesions in 2 cases and malignant in 23,while the thoracoscopic anatomic segmentectomy group contained benign lesions in 5 cases and malignant in 18. The Karnofsky performance score at one year after the surgery in the thoracoscopic anatomic segmentectomy group was（ 93. 7 ± 8. 5） points and in the thoracoscopic lobectomy group was（ 80. 3 ± 11. 1） points（ t = 4. 665,P = 0. 000）. A total of 41 patients,whose pathological examinations were malignant,were followed up for 1- 5 years,and all survived without recurrence or death. Conclusions The thoracoscopic anatomic segmentectomy is as feasible and safe as the thoracoscopic lobectomy for treatment of ground-glass nodule. Thoracoscopic anatomic segmentectomy has faster recovery and higher quality of life.