电视辅助胸腔镜手术治疗临床Ⅰ期非小细胞肺癌的疗效研究

The Research of Efficacy of Video-Assisted Thoracoscopic Surgery for Clinical stage Ⅰ Non-small Cell Lung Cancer

目的评价电视辅助胸腔镜手术(VATS)治疗临床Ⅰ期非小细胞肺癌(NSCLC)的疗效和安全性。方法行肺叶切除术的Ⅰ期NSCLC病人185例,根据病人的手术方式不同将病人分为VATS肺叶切除术组(VATS组)与常规开胸肺叶切除术组(开胸组),比较两组病人的临床资料、无病生存率(DFS)与总生存率(OS),采用Cox回归分析评价影响病人DFS与OS的预测因素。结果非小细胞肺癌病人185例,行VATS肺叶切除术87例,行常规开胸肺叶切除术98例。开胸组、VATS组手术时间分别为(124.39±28.97)分钟和(116.47±30.63)分钟,两组比较差异无统计学意义(P>0.05);住院时间分别为(10.28±3.61)天和(12.82±4.77)天,肺部并发症发生率分别为13.2%和26.5%,两组比较差异有统计学意义(P<0.05)。淋巴结取样数分别为(7.09±1.81)个和(8.13±1.74)个,N2纵隔淋巴结取样数分别为(2.25±0.58)个和(2.56±0.66)个,两组比较差异无统计学意义(P>0.05)。VATS组病人5年DFS和OS分别为57.8%和74.7%,开胸组分别为46.9%、62.2%,差异有统计学意义(P<0.05)。Cox回归分析显示,肿瘤体积较大是DFS与OS较差的预测因子。结论 VATS肺叶切除术可安全有效地治疗临床Ⅰ期NSCLC,与开胸肺叶切除术比较,VATS组病人住院时间短,肺部并发症少。淋巴结切除术结果和预后与接受开胸手术病人相当。

Objective To evaluate the efficacy and safety of video-assisted thoracoscopic surgery（VATS）in the treatment of clinical stage Ⅰ non-small cell lung cancer（NSCLC）.Methods 185 pa-tients with stage Ⅰ NSCLC who underwent lobectomy in our hospital were retrospectively analyzed.The patients were divided into VATS lobectomy group（the VATS group）and Conventional lobectomy group（the thoracotomy group）according to different surgical methods.The clinical data,disease-free survival（DFS）and overall survival（OS）were compared between the two groups.Cox regression analysis was used to predict the predictors of DFS and OS in the patients.Results A total of 185 patients were enrolled,87（47%）patients underwent VATS lobectomy,and 98（53%）patients underwent conventional thoraeotomy lobectomy.Compared with the thoracotomy group,the operation time of VATS group was longer,but the difference was not statistically significant（[124.39 ± 28.97 ）min vs.（116.47 ± 30.63 ）min,t = 1.801,P = 0.073],the hospitalization time was significantly shortened [（10.28 ± 3.61 ）d vs.（12.82± 4.77 ）d,t = 4.041,P 〈 0.001],the incidence of pulmonary complications was significantly decreased [13.2%（11/87 ）vs.26.5 %（26/98）,Х^2 = 5.555,P = 0.018],The number of lymph nodes [（7.09 ±1.81 ）vs.（8.13 ± 1.74）,t = 1.302,P =0.195]and the number of N2 mediastinal lymph nodes [（2.25±0.58）vs.（2.56±0.66）,t = 1.524,P =0.129]were similar.In VATS group,5 year DFS（57.8% vs.46.9%,logrank P = 0.014）and OS（74.7 % vs.62.2%,logrank P = 0.018 ）were significantly improved.Cox re-gression analysis showed that larger tumor volume was a poor predictor of DFS and OS.Conclusion VATS lobectomy is a safe and effective treatment for stage I non-small cell lung cancer.Compared with conventional thoracotomy,VATS patients have shorter hospitalization time and less pulmonary complica-tions,and lymph node resection results and tumor prognosis are comparable to those undergoing conven-tional thoracotomv lobectomy.