不同手术方式治疗ⅠA期非小细胞肺癌的对比研究

A comparative study of different surgical method for stageⅠA non-small cell lung cancer

目的 比较电视胸腔镜肺段切除术与肺叶切除术治疗早期非小细胞肺癌的临床疗效。方法 回顾性分析重庆市垫江县人民医院234例行电视胸腔镜下不同手术方式治疗的ⅠA期非小细胞肺癌患者的临床资料,根据手术方式的不同将患者分为肺段组和肺叶组。通过倾向性评分匹配法进行1∶1匹配平衡2组临床特征,最终每组纳入63例患者。比较2组患者手术时间、术中出血量、术后胸腔引流管留置时间、术后24 h和48 h胸腔引流量及术后住院时间等围术期指标。统计2组患者术后漏气>6 d、肺部感染、肺不张、咯血、声音嘶哑等并发症发生情况。结果 2组患者手术时间、术中出血量、术后24 h和48 h胸腔引流量、术后胸腔引流管留置时间及术后并发症发生率比较,差异均无统计学意义(P>0.05)。肺段组患者的术后住院时间短于肺叶组,差异具有统计学意义(P=0.003)。结论 对于ⅠA期非小细胞肺癌患者,电视胸腔镜肺段切除术与肺叶切除术具有相似的围术期疗效,但肺段切除术在缩短患者住院时间方面优势更明显。

Objective To compare the clinical efficacies of video-assisted thoracoscopic segmentectomy versus lobectomy for early-stage non-small cell lung cancer.Methods The clinical data of 234 patients with stageⅠA non-small cell lung cancer and undergoing different surgical methods under video-assisted thoracoscopy admitted to Chongqing Dianjiang General Hospital were retrospectively analyzed,and the patients were divided into the lung segment group and the lung lobe group according to their surgical methods.The clinical characteristics of the patients in the two groups were balanced by a 1-to-1 ratio matching through the propensity score matching method,and each group finally included 63 cases.The perioperative indicators containing operation time,intraoperative blood loss,postoperative thoracic drainage tube indwelling time,thoracic drainage volumes 24 hours and 48 hours after operation and postoperative hospital stay were compared of patients between the two groups.The incidence of postoperative complications such as air leakage>6 days,pulmonary infection,atelectasis,hemoptysis,and hoarseness in the two groups was collected.Results There was no significant difference in the operation time,intraoperative blood loss,thoracic drainage volumes 24 hours and 48 hours after operation,postoperative thoracic drainage tube indwelling time or incidence of postoperative complications of patients between the two groups(P>0.05).The postoperative hospital stay of patients in the lung segment group was shorter than that in the lung lobe group,with statistically significant difference(P=0.003).Conclusion For patients with stageⅠA non-small cell lung cancer,video-assisted thoracoscopic segmentectomy has similar perioperative efficacy to lobectomy,while segmentectomy has a more significant advantage in shortening the hospital stay.