解剖性部分肺叶切除术治疗3336例肺结节患者的疗效

Anatomical partial lobectomy for the treatment of 3336 cases of patients with lung nodule

目的探讨解剖性部分肺叶切除术的可行性、安全性和有效性。方法回顾性分析2013年11月至2019年11月于中国医学科学院肿瘤医院行解剖性部分肺叶切除术的3336例肺结节患者的临床病理资料。依据肿瘤切缘距离确定靶肺组织范围后,将区域内累及的主要血管、支气管行解剖性离断,沿切割平面切除靶肺组织,完成解剖性亚肺叶切除和系统性淋巴结清扫或采样。结果3336例肺结节患者中,多发肺结节668例,孤立性肺结节2668例。术后病理为良性283例,浸润前病变1197例(不典型腺瘤样增生38例,原位腺癌445例,微小浸润性腺癌714例),浸润性腺癌1713例,非腺癌73例,转移性癌70例。1786例浸润性原发肺癌患者中,11例行术前新辅助治疗,术后病理分期为ypⅠA期;1775例未行新辅助治疗,TNM分期为ⅠA期1587例,ⅠB期112例,ⅡA期3例,ⅡB期18例,ⅢA期37例,ⅢB期9例,Ⅳ期9例。手术时间为(127.3±55.3)min,术后住院时间为(4.8±2.4)d,≥3级并发症发生率为1.1%(38/3336),术后30 d无死亡患者。结论解剖性部分肺叶切除术具有较好的临床可行性,同时兼顾了安全性和有效性,值得在临床推广应用。

Objective To explore the feasibility,safety and effectiveness of anatomical partial lobectomy.Methods The clinical data of 3336 patients with lung nodules underwent anatomical partial lobectomy in our center from November 2013 to November 2019 were retrospectively analyzed.We set the safety margin distance according to the imaging feature of the lesion.The surgeons then anatomically detached the major vessels and bronchus in this region,resected the targeted lung tissue along the plane,and completed the resection of anatomical pulmonary lobe and clean and sampling of systemic lymph nodules.Results A total of 668 cases were multiple nodules and 2668 cases were solitary pulmonary nodules.According to the postoperative pathological results,283 cases were benign,1197 cases were preinvasive lesions(including 38 cases of atypical adenomatous hyperplasia,445 cases of adenocarcinoma in situ and 714 cases of minimally invasive adenocarcinoma),1713 cases were invasive adenocarcinoma,73 cases were non-adenocarcinoma and 70 cases were metastatic carcinoma.Among 1786 invasive primary lung cancers,11 cases received preoperative neoadjuvant chemotherapy,and their postoperative pathologic diagnoses were stage ypIA.Other 1775 cases who did not receive postoperative neoadjuvant treatment included 1587 cases in stageⅠA,112 cases in stageⅠB,3 cases in stageⅡA,18 cases in stageⅡB,37 cases in stageⅢA,9 cases in stageⅢB,9 cases in stageⅣ.The average operation time was(127.3±55.3)minutes,and the mean postoperative hospital stay was(4.8±2.4)days.The incidence rate of complications(grade>2)was 1.1%(38/3336),and no death occurred during 30 days after operation.Conclusion Anatomic partial lobectomy has good clinical applicability,safety and effectiveness,which is worthy of clinical application and recommendation.