胸腔镜肺段切除术和肺叶切除术治疗老年早期非小细胞肺癌患者的疗效比较

Thoracoscopic pulmonary segmentectomy versus lobectomy in the treatment of early non-small cell lung cancer in elderly patients

目的探讨胸腔镜肺段切除术和胸腔镜肺叶切除术治疗老年早期非小细胞肺癌(NSCLC)患者的疗效差异。方法回顾性分析接受胸腔镜切除手术(VATS)的82例老年早期NSCLC患者的临床资料,将34例接受胸腔镜肺段切除术的患者纳入肺段切除组,将48例接受胸腔镜肺叶切除术的患者纳入肺叶切除组。比较2组患者围术期相关指标,并比较术后12个月随访结果及肺功能检测情况。结果2组手术出血量、淋巴结清扫数、术后引流量、住院时间和住院费用比较,差异均无统计学意义(P>0.05);肺段切除组手术耗时(170.43±25.90)min,显著长于肺叶切除组的(158.70±22.76)min(P<0.05);肺段切除组近期手术并发症发生率为8.82%,低于肺叶切除组的12.50%,但差异无统计学意义(P>0.05);术后12个月随访显示,2组均未出现肿瘤复发、转移或死亡病例,而肺段切除组患者肺功能指标用力肺活量(FVC)、第1秒用力呼气容积(FEV 1)和最大通气量(MVV)的下降率均显著低于肺叶切除组(P<0.05)。结论胸腔镜肺段切除术和肺叶切除术均是治疗老年早期NSCLC患者的有效微创术式,二者近期手术疗效相近,但前者对患者肺功能的影响较小,尤其适用于肺功能较差或不耐受肺叶切除的老年NSCLC患者。

Objective To compare effect difference between thoracoscopic pulmonary segmental resection and segmental resection in the treatment of early non-small cell lung cancer(NSCLC)in elderly patients.Methods The clinical data of 82 elderly patients with early NSCLC who underwent video-assisted thoracoscopic surgery(VATS)in thoracic surgery were retrospectively analyzed.A total of 34 patients with thoracoscopic pulmonary segmentectomy were selected as pulmonary segmentectomy group,and 48 patients with thoracoscopic lobectomy were selected as lobectomy group.The indexes of perioperative period were compared between the two groups,and postoperative follow-up results after 12 months and pulmonary function were compared.Results There were no significant differences in amount of bleeding,the number of lymph node dissection,amount of postoperative drainage,length of hospital stay and cost of hospitalization between the groups(P>0.05).The operation time in the pulmonary segmentectomy group was(170.43±25.90)min,which was longer than(158.70±22.76)min in the lobectomy group(P<0.05);the incidence of operative complications in pulmonary segmentectomy group was 8.82%,which was significantly lower than 12.50%in the lobectomy group,but the difference was not significant(P>0.05).Postoperative 12-month follow-up showed that there were no recurrence,metastasis or death patients in the two groups.However,the decrease rate of forced vital capacity(FVC),forced expiratory volume in one second(FEV 1),maximal voluntary ventilation(MVV)in the pulmonary segmentectomy group were lower than those in the lobectomy group(P<0.05).Conclusion Thoracoscopic pulmonary segmental resection and lobectomy are both effective and minimally invasive methods in the treatment of early stage NSCLC in the elderly.They have similar short-term effect,but the former has little effect on the pulmonary function,especially for the elderly NSCLC patients with poor pulmonary function or intolerance of lobectomy.