开放与全胸腔镜肺叶切除术对隐匿性N2期NSCLC患者手术相关临床指标、淋巴结清扫效果及术后并发症的影响

Influence of open and VATS operation scheme on operation-related clinical indicators,lymph node dissection effect and postoperative complications of patients with NSCLC at latent N2 stage

目的探讨开放与全胸腔镜肺叶切除术对隐匿性N2期NSCLC患者手术相关临床指标、淋巴结清扫效果及术后并发症的影响。方法回顾性选取我院2011年8月-2014年8月收治隐匿性N2期NSCLC患者共110例,根据手术方案不同分为开放组(62例)和VATS组(48例),分别采用开放与全胸腔镜肺叶切除术;比较两组患者手术用时、术后引流量、住院总时间、住院总医疗费用、淋巴结清扫总个数、纵隔淋巴结清扫个数、术后并发症发生率及随访生存率。结果 VATS组患者手术用时和住院总医疗费用均显著多于开放组(P <0. 05); VATS组患者术后引流量和住院总时间均显著少于开放组(P <0. 05);两组患者淋巴结清扫总个数和纵隔淋巴结清扫个数比较差异无统计学意义(P> 0. 05);两组患者术后并发症发生率比较差异无统计学意义(P> 0. 05);同时VATS组患者随访生存率显著高于开放组(P <0. 05)。结论开放与全胸腔镜肺叶切除术治疗隐匿性N2期NSCLC在淋巴结清除效果和手术安全性方面较为接近;但全胸腔镜肺叶切除术应用可有效加快机体康复进程,提高远期生存率。

Objective To investigate the influence of open and VATS operation scheme on operation-related clinical indicators, lymph node dissection effect and postoperative complications of patients with NSCLC at latent N2 stage. Methods 110 patients with NSCLC at latent N2 stage were chosen from August 2011 to August 2014 in our hospital and divided into two groups according to operation scheme including the open group （62 patients） with open operation and the VATS group （48 patients） with VATS operation. Their operation time, postoperative drainage volume, total hospitalization time and expense, the total number of lymph node dissection, the number of mediastinal lymph node dissection, postoperative complication incidence and the survival rate were compared between the two groups. Results The operation time and the total hospitalization expense of the VATS group were more than those of the open group （ P〈 0.05）. The postoperative drainage volume and the total hospitalization time of the VATS group were significantly less than those of the open group （ P〈 0.05）. There was no significant difference in the total number of lymph node dissection and the number of mediastinal lymph node dissection between the two groups （ P〉 0.05）. The survival rate was significantly higher in the VATS group than in the open group （ P〈 0.05）. Conclusion Open and VATS operation has similar lymph node clearance and surgery safety in treatment of patients with NSCLC at latent N2 stage, but VATS operation can efficiently speed up the rehabilitation process and have higher the long-term survival rate.