全胸腔镜下肺叶切除联合系统淋巴清扫治疗肺癌的临床效果及其影响因素分析
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摘要
目的:探究全胸腔镜下肺叶切除(VATS)联合系统淋巴清扫治疗肺癌的临床效果及其影响因素。方法:以2012年1月至2015年7月64例肺癌患者为研究对象,按分层随机分组分为观察组与对照组,各32例。观察组采用VATS联合系统淋巴清扫治疗,对照组采用传统开胸肺叶切除联合系统淋巴清扫治疗,随访3年,使用Kaplan-Meier生存曲线分析两组中位生存时间及生存率,并应用多因素Cox回归分析观察组患者临床效果的影响因素。结果:观察组中位生存时间为27个月,1、2、3年生存率为87.50%、68.75%、40.63%;对照组中位生存时间为25个月,1、2、3年生存率为84.38%、62.50%、34.38%;Kaplan-Meier生存曲线分析显示两组总体生存时间分布无显著差异(P>0.05);单因素分析显示临床分期、病灶长度、组织分化、清扫淋巴结个数及术后化疗与观察组患者3年生存率相关(P <0.05),多因素Cox回归分析显示临床分期及清扫淋巴结个数是影响观察组患者预后的独立影响因素(P <0.05)。结论:VATS联合系统淋巴清扫治疗与传统开胸肺叶切除联合系统淋巴清扫治疗的临床效果相当;临床分期及清扫淋巴结个数是影响其预后的独立影响因素,应引起临床重视。
Objective:To investigate the clinical effect of video-asisted thoracoscopic surgery(VATS)combined with systematic lymphadenectomy in the treatment of lung cancer and the influencing factors.Methods:A total of 64 patients with lung cancer who were admitted to the hospital from January 2012 to July 2015 were enrolled in the study.They were divided into the observation group and the control group by the stratified random grouping,32 cases in each group.The observation group was treated with VATS combined systematic lymphadenectomy,while the control group was treated with traditional open thoracotomy lobectomy and systemic lymphadenectomy.All patients were followed up for 3 years.Kaplan-Meier survival curve was used to analyze the median survival time and survival rate of both groups,and multivariate Cox regression analysis was performed to analyze factors affecting the clinical effect in the observation group.Results:The median survival time of the observation group was 27 months,and the 1-year,2-year and 3-year survival rates were 87.50%,68.75% and 40.63%.The median survival time of the control group was 25 months,and the 1-year,2-year and 3-year survival rates were 84.38%,62.50% and 34.38%.Kaplan-Meier survival curve analysis showed that there was no significant difference in overall survival time between the two groups(P >0.05).Univariate analysis showed that clinical stage,length of the lesion,tissue differentiation,number of lymph nodes removed and postoperative chemotherapy were closely related to the 3-year survival rates in the observation group(P <0.05).Multivariate Cox regression analysis showed that the clinical stage and the number of lymph nodes removed were independent factors influencing the prognosis in the observation group(P < 0.05).Conclusion:The clinical effect of VATS combined with systematic lymphadenectomy is similar to that of traditional thoracotomy lobectomy combined with lymphadenectomy.Clinical stage and number of lymph nodes removed are independent influencing factors,which needs clinical attention.
Objective:To investigate the clinical effect of video-asisted thoracoscopic surgery(VATS)combined with systematic lymphadenectomy in the treatment of lung cancer and the influencing factors.Methods:A total of 64 patients with lung cancer who were admitted to the hospital from January 2012 to July 2015 were enrolled in the study.They were divided into the observation group and the control group by the stratified random grouping,32 cases in each group.The observation group was treated with VATS combined systematic lymphadenectomy,while the control group was treated with traditional open thoracotomy lobectomy and systemic lymphadenectomy.All patients were followed up for 3 years.Kaplan-Meier survival curve was used to analyze the median survival time and survival rate of both groups,and multivariate Cox regression analysis was performed to analyze factors affecting the clinical effect in the observation group.Results:The median survival time of the observation group was 27 months,and the 1-year,2-year and 3-year survival rates were 87.50%,68.75% and 40.63%.The median survival time of the control group was 25 months,and the 1-year,2-year and 3-year survival rates were 84.38%,62.50% and 34.38%.Kaplan-Meier survival curve analysis showed that there was no significant difference in overall survival time between the two groups(P >0.05).Univariate analysis showed that clinical stage,length of the lesion,tissue differentiation,number of lymph nodes removed and postoperative chemotherapy were closely related to the 3-year survival rates in the observation group(P <0.05).Multivariate Cox regression analysis showed that the clinical stage and the number of lymph nodes removed were independent factors influencing the prognosis in the observation group(P < 0.05).Conclusion:The clinical effect of VATS combined with systematic lymphadenectomy is similar to that of traditional thoracotomy lobectomy combined with lymphadenectomy.Clinical stage and number of lymph nodes removed are independent influencing factors,which needs clinical attention.
引文
[1]张庆永.两孔胸腔镜肺叶切除及系统性淋巴结清扫手术治疗肺癌的临床疗效观察[J].标记免疫分析与临床,2016,23(9):1064~1067.
[2]马幸生,钟钏,尹松林,等.全胸腔镜肺叶切除联合淋巴结清扫术治疗高龄非小细胞肺癌患者的疗效观察[J].现代生物医学进展,2016,16(21):4103~4105.
[3]周胜年,胡泽东,时应路.肺癌患者单孔胸腔镜肺叶切除术和系统性淋巴结清扫手术治疗的疗效观察[J].中国肿瘤临床与康复,2016,23(8):939~942.
[4]张涛,魏元福.胸腔镜下肺叶切除联合淋巴结清扫术治疗肺癌71例效果研究[J].现代医学,2017,45(6):828~830.
[5]许辰阳,吉灵,曾淦华,等.全胸腔镜肺叶切除联合淋巴结清扫术在肺癌中的应用[J].重庆医学,2013,42(25):3034~3035.
[6]吕振业,戈洁梦,冯锐,等.完全胸腔镜下肺叶切除加纵隔淋巴结清扫术在肺癌治疗中的应用研究[J].浙江医学,2017,39(3):204~207.
[7]孟祥宽,孙振宇,罗静娴,等.电视胸腔镜治疗非小细胞肺癌的疗效及影响因素[J].临床肺科杂志,2016,21(11):2067~2070.
[8]滕洪生,张志伟,杨洋.胸腔镜肺叶切除治疗非小细胞肺癌的近远期疗效及影响因素分析[J].重庆医学,2014,43(14):1764~1767.
[2]马幸生,钟钏,尹松林,等.全胸腔镜肺叶切除联合淋巴结清扫术治疗高龄非小细胞肺癌患者的疗效观察[J].现代生物医学进展,2016,16(21):4103~4105.
[3]周胜年,胡泽东,时应路.肺癌患者单孔胸腔镜肺叶切除术和系统性淋巴结清扫手术治疗的疗效观察[J].中国肿瘤临床与康复,2016,23(8):939~942.
[4]张涛,魏元福.胸腔镜下肺叶切除联合淋巴结清扫术治疗肺癌71例效果研究[J].现代医学,2017,45(6):828~830.
[5]许辰阳,吉灵,曾淦华,等.全胸腔镜肺叶切除联合淋巴结清扫术在肺癌中的应用[J].重庆医学,2013,42(25):3034~3035.
[6]吕振业,戈洁梦,冯锐,等.完全胸腔镜下肺叶切除加纵隔淋巴结清扫术在肺癌治疗中的应用研究[J].浙江医学,2017,39(3):204~207.
[7]孟祥宽,孙振宇,罗静娴,等.电视胸腔镜治疗非小细胞肺癌的疗效及影响因素[J].临床肺科杂志,2016,21(11):2067~2070.
[8]滕洪生,张志伟,杨洋.胸腔镜肺叶切除治疗非小细胞肺癌的近远期疗效及影响因素分析[J].重庆医学,2014,43(14):1764~1767.