完全胸腔镜下肺叶切除加纵隔淋巴结清扫术在肺癌治疗中的应用研究

Video-assisted thoracoscopic lobectomy with mediastinal lymphadenectomy in treatment of non-small cell lung cancer

目的比较完全胸腔镜下肺叶切除加纵隔淋巴结清扫术与小切口辅助胸腔镜肺叶切除加纵隔淋巴结清扫术两种手术方法治疗非小细胞肺癌的优缺点。方法将46例周围型非小细胞肺癌且有相应手术指征的患者分成两组,即完全胸腔镜组(完全胸腔镜手术加纵隔淋巴结清扫术)与小切口辅助胸腔镜组(小切口辅助胸腔镜手术加纵隔淋巴结清扫术)。比较两组在胸腔内操作时间、术中出血量、淋巴结清扫数量、术后引流液量、止痛药物使用时间、拔管时间、术后并发症、住院时间、病理情况及手术并发症。结果两组患者均顺利完成手术。无中转开胸及大出血情况发生,无围术期死亡病例。完全胸腔镜组出血量(155.2±42.7)ml、止痛药物使用时间(6.8±1.2)d、引流液量(517.4±76.1)ml、拔管时间(4.8±0.8)d及住院时间(7.3±0.8)d均少于或短于小切口辅助组[(213.3±56.1)ml、(8.2±1.3)d、(633.0±80.5)ml、(5.8±1.0)d、(8.9±1.0)d],手术时间(129.8±23.9)min长于小切口辅助组(112.8±16.0)min,差异均有统计学意义(均P<0.01)。两组患者淋巴结清扫数量[(14.2±2.2)个vs(13.9±2.1)个]及并发症发生率差异均无统计学意义(均P>0.05)。结论完全胸腔镜下肺叶切除加纵隔淋巴结清扫术治疗非小细胞肺癌适合于早中期肺癌,可以作为早中期非小细胞型肺癌的一种可行的、比较安全的手术方式,并可以成为一种标准的手术方式。

Objective To evaluate the application of video-assisted thoracoscopic surgery（VATS） lobectomy plus mediastinal lymphadenectomy in treatment of non-small cell lung cancer（NSCLC）.Methods Forty six patients with peripheral NSCLC admitted in hospital between November 2013 and October 2015 were treated with video-assisted thoracoscopic（VATS）lobectomy plus mediastinal lymphadenectomy（VATS group） or video-assisted mini-thoracotomy（VAMT） lobectomy plus mediastinal lymphadenectomy（VAMT group）.The operation time,intraoperative blood loss,number of dissected lymph nodes,volume of post operation drainage,duration of postoperative analgesia,time of chest tube removal,postoperative complications and length of stay were documented and compared between two groups.Results All the operations were successfully performed,and no serious complication or death occurred perioperatively in both groups.There were statistical differences in operation time（129.8±23.9min vs 112.8±16.0min,P〈0.01）,intraoperative blood loss（155.2±42.7ml vs.213.3±56.1ml,P〈0.01）,volume of post operative drainage（517.4±76.1ml vs.633.0±80.5ml,P〈0.01）,duration of postoperative analgesia（6.8±1.2d vs.8.2±1.3d,P〈0.01）,time of chest tube removal（4.8±0.8d vs.5.8±1.0d,P〈0.01）,length of stay（7.3±0.8d vs.8.9±1.0d,P〈0.01）between VATS group and VAMT group.There were no statistical difference in the number of dissected lymph nodes（14.2±2.2 vs.13.9±2.1,P〉0.05） and incidence of postoperative complications（P〉0.05） between two groups.Conclusion Video-assisted thoracoscopic lobectomy plus mediastinal lymphadenectomy is a feasible and safe approach for treating early and middle stage non-small cell lung cancer.