胸腔镜下肺亚段切除术临床可行性研究

Clinical feasibility study of thoracoscopic subsegmental pulmonary resection

目的:通过与胸腔镜下肺段切除术比较,探讨胸腔镜下肺亚段切除术在临床实践中的可行性及安全性。方法:收集行胸腔镜解剖性亚肺叶切除术的单发肺小结节病人90例,根据手术方式分为胸腔镜下肺亚段切除术组(亚段组)34例和胸腔镜下肺段切除术组(肺段组)56例,比较2组病人围手术期相关指标和早期疗效。结果:亚段组病人切除亚段数、术中出血量、标本切缘距离均明显少于肺段组(P<0.01),2组手术时间、术后胸腔引流量、术后置管时间、术后住院时间差异均无统计学意义(P>0.05)。2组病人术后并发症、病理诊断、TNM分期差异均无统计学意义(P>0.05),亚段组Ⅰ期切除淋巴结站数明显少于肺段组(P<0.01)。2组术后随访期间均无肿瘤复发及转移。结论:以亚段为单位行胸腔镜下肺亚段切除能在保证切缘前提下切除更少的肺组织,可用于早期非小细胞肺癌的治疗。

Objective:To investigate the feasibility and safety of thoracoscopic subsegmental pulmonary resection in clinical practice by comparing thoracoscopic pulmonary segment resection.Methods:The clinical data of 90 single pulmonary nodule patients treated with thoracoscopic anatomic sublobectomy were retrospectively analyzed.According to the surgical methods,the patients were divided into the thoracoscopic subsegmental pulmonary resection group(subsegment group,34 cases)and thoracoscopic lower pulmonary segment resection group(pulmonary segment group,56 cases).The perioperative indicators and early efficacy between two groups were compared.Results:The number of patients with subsegments resection,intraoperative blood loss and distance of resection margin in subsegment group were significantly less than those in pulmonary segment group(P<0.01),and the differences of the operative time,postoperative chest drainage,postoperative catheter time and postoperative hospital stay between two groups were not statistically significant(P>0.05).The differences of the postoperative complications,pathological diagnosis and TNM staging between two groups were not statistically significant(P>0.05),and the number of stageⅠlymph node resection in subsegment group were significantly less than that in pulmonary segment group(P<0.01).The tumor recurrence and metastasis in two groups during postoperative following up were not found.Conclusions:The thoracoscopic subsegmental pulmonary resection can remove less lung tissue on the premise of ensuring the cutting edge,which can be used in the treatment of early non-small-cell lung cancer.