全腔镜肺叶切除与开胸肺叶切除治疗早期肺癌1年随访

1 year follow up of endoscopic lobectomy and thoracotomy lobectomy for pulmonary lobectomy in early lung cancer

目的探讨全腔镜肺叶切除与开胸肺叶切除治疗对早期肺癌患者肺功能、并发症、生活质量等的影响。方法146例早期肺癌患者根据患者意愿,以手术方式不同,分成两组,其中67例实施传统开胸肺叶切除术(开胸组),另外79例实施全腔镜肺叶切除术(全腔镜组)。对两组术中和术后恢复情况、肺功能指标、生活质量、术后并发症、术后1年预后情况进行对比。结果全腔镜组手术时间明显长于开胸组(P<0.05),但术中失血量、术后引流量要明显少于开胸组(P<0.05),切口长度、术后住院时间均明显短于开胸组(P<0.05),术后伤口疼痛程度显著低于开胸组(P<0.05),淋巴结清除个数组间无统计学差异(P>0.05)。术后1 w,两组肺功能1秒用力呼气容积(FEV1)和每分钟最大通气量(MVV)明显下降,但全腔镜组显著优于开胸组(P<0.05);在术后1年,两组肺功能已基本达到术前水平,且组间水平无统计学差异(P>0.05)。术后3个月,两组肺癌症状量表(LCSS)得分和肺癌患者生存质量测定量表(FACT-L)均较术前显著降低(P<0.05),全腔镜组LCSS得分较开胸组明显降低(P<0.05),FACT-L得分较开胸组显著升高(P<0.05);术后1年,LCSS得分的组间差异无统计学意义(P>0.05),两组FACT-L得分均达到术前水平,组间差异无统计学意义(P>0.05)。全腔镜组并发症发生率明显低于开胸组(P<0.05)。术后1年,组间在复发、远处转移和生存率差异均无统计学意义(P>0.05)。结论全腔镜肺叶切除与开胸肺叶切除治疗早期肺癌均可达到满意效果,在远期预后上效果相当,且全腔镜方案术中创伤小、术后恢复快、并发症低。

Objective To analyze the differences in lung function,complications and quality of life between total endoscopic lobectomy and thoracotomy lobectomy for pulmonary lobectomy in early lung cancer by the follow-up of 1 years.Methods According to the wishes of patients and different surgical methods,146 cases of early lung cancer patients were divided into two groups with 67 cases with traditional thoracotomy lobectomy(thoracotomy group)and 79 cases with thoracoscopic lobectomy(thoracoscopic group).Intraoperative and postoperative recovery,pulmonary function,quality of life,postoperative complications,and postoperative 1 year prognosis of two groups were compared.Results The operation time of endoscopic group was longer than that of thoracotomy group(P<0.05),the intraoperative blood loss and postoperative drainage volume were significantly less than those of the thoracotomy group(P<0.05),the incision length was shorter than that of thoracotomy group(P<0.05),the postoperative hospital stay was shorter than that in the thoracotomy group(P<0.05),the degree of wound pain was significantly lower than that of thoracotomy group(P<0.05).There was no difference between the groups in the number of lymph node clearance(P>0.05).At 1 weeks after operation,FEV1 and MVV of the two groups decreased significantly due to the operation,but the endoscopic group was superior to the thoracotomy group(P<0.05).In 1 year after operation,the lung function of the two groups had reached the preoperative level,and the level of the lung function was similar between the two groups(P>0.05).At 3 months after operation,LCSS score and FACT-L score of the two groups were lower than before operation,and the LCSS score of the whole endoscopic group was lower than those of the thoracotomy group,and the FACT-L score was higher than that of thoracotomy group.There was no significant difference in LCSS score between two groups after operation 1 years(P>0.05).The FACT-L scores of the two groups all reached the preoperative level,and there was no significant difference between the two groups(P>0.05).The complication rate of the endoscopic group was 10.13%,which was significantly lower than that of thoracotomy group(25.37%,P<0.05).There was no significant difference in recurrence,distant metastasis and survival rate between the groups after 1 year operation(P>0.05).Conclusions Both endoscopic lobectomy and thoracotomy lobectomy could achieve satisfactory results in the early stage of lung cancer,and have the same prognosis,however,the endoscopic surgery is minimally invasive,fast postoperative recovery and low complications.