胸腔镜肺段和肺叶切除术治疗早期非小细胞肺癌的临床对比研究

Clinical Comparative Study of Thoracoscopic Lung Segmentectomy and Lobectomy in Treatment of Early Non-small Cell Lung Cancer

目的观察胸腔镜下肺段及肺叶切除术治疗早期非小细胞肺癌(NSCLC)的有效性及安全性。方法收集2015年10月至2017年9月在重庆医科大学附属第一医院胸外科接受胸腔镜下肺段或肺叶切除的早期NSCLC患者132例,其中胸腔镜下肺段切除术患者65例,胸腔镜下肺叶切除术患者67例,分别作为观察组和对照组,比较两组患者围术期相关临床指标(手术时间、术后总引流量、抗生素运用时间等)的变化情况。结果两组患者均在胸腔镜下顺利完成手术,无围术期死亡和中转开胸。两组术中出血量、总费用比较差异无统计学意义(P> 0. 05)。但与对照组相比,观察组的手术时间延长[(148±23) min比(134±22) min],术后总引流量减少[(331±215) m L比(799±317) m L],抗生素运用时间、术后住院时间、重症监护病房停留时间、胸腔引流时间缩短[(3. 0±1. 7) d比(4. 0±2. 1) d,(3. 6±2. 0) d比(5. 2±2. 4) d,(1. 2±0. 4) d比(2. 0±0. 9) d,(3. 0±2. 0) d比(4. 3±2. 2) d](P <0. 01),术后并发症发生率降低[7. 6%(5/65)比20. 8%(14/67)](P <0. 05)。结论对于早期NSCLC患者,胸腔镜下肺段及肺叶切除术均安全、可靠,且与胸腔镜肺叶切除术相比,胸腔镜肺段切除术能保留更多的健康肺组织,创伤更小、术后恢复更快。

Objective To observe the efficacy and safety of thoracoscopic pulmonary segmentectomy and lobectomy in the treatment of early non-small cell lung cancer (NSCLC). Methods A total of 132 patients with early NSCLC who underwent thoracoscopic pulmonary segmentectomy or lobectomy from Oct.2015 to Sep. 2017 in the First Affiliated Hospital of Chongqing Medical University were collected,65 cases who were treated with thoracoscopic pulmonary segmentectomy as an observation group,and 67 cases who were treated with thoracoscopic pulmonary lobectomy as a control group.The changes of perioperative clinical indexes (operation time,total drainage volume,antibiotic usage time,etc.) of the two groups were compared. Results No perioperative death and conversion to thoracotomy were found in both groups.There were no significant differences in volume of intraoperative bleeding and total cost between the two groups( P >0.05).But compared with the control group,the operation time of the observation group was prolonged [(148±23) min vs (134±22) min],the total drainage volume was reduced[(331±215) mL vs (799±317) mL],the antibiotic usage time,the hospital stay time,intensive care unit stay time,the time of thoracic drainage were shortened[(3.0±1.7) d vs (4.0±2.1) d,(3.6± 2.0 ) d vs (5.2±2.4) d,(1.2±0.4) d vs (2.0±0.9) d,(3.0±2.0) d vs (4.3±2.2) d]( P <0.01),and the incidence of complications was reduced [7.6%(5/65) vs 20.8%(14/67)]( P <0.05). Conclusion For early NSCLC patients,thoracoscopic pulmonary segmentectomy and lobectomy are safe and reliable,and compared with thoracoscopic lobectomy,thoracoscopic pulmonary segmentectomy can retain more healthy lung tissue,with less trauma and faster recovery.