胸腔镜下肺叶切除术与亚肺叶切除术对早期非小细胞肺癌的临床疗效及远期疗效比较

Comparison of clinical efficacy and long-term efficacy of thoracoscopic lobectomy and lobectomy on early non-small cell lung cancer

目的比较胸腔镜下肺叶切除术与亚肺叶切除术对早期非小细胞肺癌的临床疗效及远期疗效。方法选取74例早期非小细胞肺癌患者进行前瞻性研究,按照随机数字表顺序分为胸腔镜下肺叶切除术组(A组)和胸腔镜下亚肺叶切除术组(B组),分析两组术中观察指标、术后患者生活质量及5年内生存率。结果 A组闭式引流时间例数、肺不张比率均高于B组(P<0.05);术后1年、3年各组角色、情绪、认知、社会等功能及总健康状况评分均显著高于术前(P<0.05),而躯体功能、疲倦、气促、失眠、疼痛、咳嗽评分低于术前(P<0.05);A组在术后1年、3年躯体功能、总健康状况评分低于B组(P<0.05),而疲倦、气促评分高于B组(P<0.05);Kaplan-Meier分析显示,A组5年内生存率为84.78%,B组为60.71%,A组5年内生存率高于B组,差异有统计学意义(P>0.05);Cox模型分析,年龄、手术方式为患者远期死亡的危险因素。结论解剖性肺段切除术治疗早期非小细胞肺癌术后并发症少于肺叶切除术,且患者术后生活质量优于肺叶切除术,但5年内总生存率低于肺叶切除术患者。

Objective To investigate the comparison of the clinical efficacy and long-term efficacy of thoracoscopic lobectomy and lobectomy on early stage non-small cell lung cancer.Methods74cases of early stage non-small cell lung cancer were randomly divided into thoracoscopic lobectomy group(group A)and thoracoscopic lobectomy group(group B).To analysis the comparison of intraoperative observation index,postoperative quality of life and5years survival rate in the two groups after operation.Results The cases of closed drainage time,atelectasis,left ventricular failure rate of group A were higher than group B(P<0.05).After1year,3years,the scores of role,emotional,cognitive,social,function and overall health status in each group were significantly higher than the preoperative score(P<0.05).The scores of physical function,fatigue,shortness of breath,insomnia,pain,cough were lower than the preoperative score(P<0.05).After1year,3-year the scores of physical function,overall health status score in group A were lower than group B(P<0.05),as well as the scores of fatigue,shortness of breath were higher in group A than group B(P<0.05).Kaplan-Meier analysis showed that the5-year survival rate was84.78%in group A and60.71%in group B,and the5-year survival rate in group A was higher than that in group B(P>0.05).Cox model analysis showed that Age was the risk factor for long-term mortality in patients.Conclusion Postoperative complications with sub pulmonary lobectomy(anatomy of pulmonary segment resection)in the treatment of early NSCLC was lower than thoracoscopic lobectomy,and the life quality was postoperative than thoracoscopic lobectomy,while the5-year survival rate in the two groups was considerable.