VATS与开胸手术治疗新辅助化疗后局部晚期肺鳞癌的疗效比较

Comparison on effect of VATS and thoracotomy in the treatment of locally advanced lung squamous cell carcinoma after neoadjuvant chemotherapy

目的 比较新辅助化疗后电视辅助胸腔镜手术(VATS)和开胸术治疗局部晚期肺鳞癌的效果。方法 回顾性收集河南省胸科医院2017年1月至2020年12月新辅助化疗后行手术切除的55例局部晚期肺鳞癌患者的临床和病理资料。其中行开胸术30例(纳入开胸组),VATS 25例(纳入VATS组)。比较两组患者新辅助化疗治疗效果、围术期相关指标、无病生存期和总生存期。结果 VATS组与开胸组新辅助化疗后效果比较,差异未见统计学意义(P>0.05)。与开胸组比较,除术中清扫淋巴结的数量多于VATS组外,VATS组中手术时间、术中失血量、术后疼痛分数、胸腔引流量、胸腔引流时间和住院天数均较少,差异有统计学意义(P<0.05)。开胸组和VATS组切除淋巴结的组数比较,差异未见统计学意义(P>0.05)。开胸组和VATS组患者无病生存期和总生存期比较,差异未见统计学意义(P>0.05)。结论 与开胸组比较,VATS组新辅助化疗后的局部晚期肺鳞癌患者术后恢复快,并且具有与开胸组类似的手术安全性和生存时间。

Objective To compare the effects of video-assisted thoracoscopy surgery(VATS)and thoracotomy after neoadjuvant chemotherapy on locally advanced lung squamous cell carcinoma.Methods The clinical and pathological data of 55 patients with locally advanced lung squamous cell carcinoma who underwent surgical resection after neoadjuvant chemotherapy from January 2017 to December 2020 in Henan Provincial Chest Hospital were retrospectively collected.Among them,30 cases underwent thoracotomy(included in the thoracotomy group)and 25 cases underwent VATS(included in the VATS group).The effects of neoadjuvant chemotherapy treatment,perioperative-related indexes,disease-free survival time,and overall survival time were compared between the two groups.Results There was no significant difference in the effects between the VATS group and the thoracotomy group after neoadjuvant chemotherapy(P>0.05).Compared with the thoracotomy group,except for the number of lymph nodes removed during operation was higher than that in the VATS group,the operation time,intraoperative blood loss,postoperative pain score,thoracic drainage volume,thoracic drainage time and days in hospital were all lower in the VATS group,and there were significant differences(P<0.05).There was no significant difference in the groups of resected lymph nodes between the thoracotomy group and VATS group(P>0.05).There was no significant difference in the disease-free survival time and overall survival time between the thoracotomy group and the VATS group(P>0.05).Conclusions Compared with the thoracotomy group,the patients with locally advanced lung squamous cell carcinoma after neoadjuvant chemotherapy in the VATS group recover quickly after surgery and have similar surgical safety and survival time as those in the thoracotomy group.