胸腔镜肺段和肺叶切除术治疗早期非小细胞肺癌的临床对比研究
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摘要
目的观察胸腔镜下肺段及肺叶切除术治疗早期非小细胞肺癌(NSCLC)的有效性及安全性。方法收集2015年10月至2017年9月在重庆医科大学附属第一医院胸外科接受胸腔镜下肺段或肺叶切除的早期NSCLC患者132例,其中胸腔镜下肺段切除术患者65例,胸腔镜下肺叶切除术患者67例,分别作为观察组和对照组,比较两组患者围术期相关临床指标(手术时间、术后总引流量、抗生素运用时间等)的变化情况。结果两组患者均在胸腔镜下顺利完成手术,无围术期死亡和中转开胸。两组术中出血量、总费用比较差异无统计学意义(P> 0. 05)。但与对照组相比,观察组的手术时间延长[(148±23) min比(134±22) min],术后总引流量减少[(331±215) m L比(799±317) m L],抗生素运用时间、术后住院时间、重症监护病房停留时间、胸腔引流时间缩短[(3. 0±1. 7) d比(4. 0±2. 1) d,(3. 6±2. 0) d比(5. 2±2. 4) d,(1. 2±0. 4) d比(2. 0±0. 9) d,(3. 0±2. 0) d比(4. 3±2. 2) d](P <0. 01),术后并发症发生率降低[7. 6%(5/65)比20. 8%(14/67)](P <0. 05)。结论对于早期NSCLC患者,胸腔镜下肺段及肺叶切除术均安全、可靠,且与胸腔镜肺叶切除术相比,胸腔镜肺段切除术能保留更多的健康肺组织,创伤更小、术后恢复更快。
Objective To observe the efficacy and safety of thoracoscopic pulmonary segmentectomy and lobectomy in the treatment of early non-small cell lung cancer( NSCLC). Methods A total of 132 patients with early NSCLC who underwent thoracoscopic pulmonary segmentectomy or lobectomy from Oct. 2015 to Sep. 2017 in the First Affiliated Hospital of Chongqing Medical University were collected,65 cases who were treated with thoracoscopic pulmonary segmentectomy as an observation group,and 67 cases who were treated with thoracoscopic pulmonary lobectomy as a control group. The changes of perioperative clinical indexes( operation time,total drainage volume,antibiotic usage time,etc.) of the two groups were compared. Results No perioperative death and conversion to thoracotomy were found in both groups. There were no significant differences in volume of intraoperative bleeding and total cost between the two groups( P > 0. 05). But compared with the control group,the operation time of the observation group was prolonged [( 148 ± 23) min vs( 134 ± 22) min],the total drainage volume was reduced[( 331 ± 215) m L vs( 799 ± 317) m L],the antibiotic usage time,the hospital stay time,intensive care unit stay time,the time of thoracic drainage were shortened[( 3. 0 ± 1. 7) d vs( 4. 0 ± 2. 1) d,( 3. 6 ± 2. 0) d vs( 5. 2 ± 2. 4) d,( 1. 2 ± 0. 4) d vs( 2. 0 ± 0. 9) d,( 3. 0 ± 2. 0) d vs( 4. 3 ± 2. 2) d]( P < 0. 01),and the incidence of complications was reduced[7. 6%( 5/65) vs 20. 8%( 14/67) ]( P < 0. 05). Conclusion For early NSCLC patients,thoracoscopic pulmonary segmentectomy and lobectomy are safe and reliable,and compared with thoracoscopic lobectomy,thoracoscopic pulmonary segmentectomy can retain more healthy lung tissue,with less trauma and faster recovery.
Objective To observe the efficacy and safety of thoracoscopic pulmonary segmentectomy and lobectomy in the treatment of early non-small cell lung cancer( NSCLC). Methods A total of 132 patients with early NSCLC who underwent thoracoscopic pulmonary segmentectomy or lobectomy from Oct. 2015 to Sep. 2017 in the First Affiliated Hospital of Chongqing Medical University were collected,65 cases who were treated with thoracoscopic pulmonary segmentectomy as an observation group,and 67 cases who were treated with thoracoscopic pulmonary lobectomy as a control group. The changes of perioperative clinical indexes( operation time,total drainage volume,antibiotic usage time,etc.) of the two groups were compared. Results No perioperative death and conversion to thoracotomy were found in both groups. There were no significant differences in volume of intraoperative bleeding and total cost between the two groups( P > 0. 05). But compared with the control group,the operation time of the observation group was prolonged [( 148 ± 23) min vs( 134 ± 22) min],the total drainage volume was reduced[( 331 ± 215) m L vs( 799 ± 317) m L],the antibiotic usage time,the hospital stay time,intensive care unit stay time,the time of thoracic drainage were shortened[( 3. 0 ± 1. 7) d vs( 4. 0 ± 2. 1) d,( 3. 6 ± 2. 0) d vs( 5. 2 ± 2. 4) d,( 1. 2 ± 0. 4) d vs( 2. 0 ± 0. 9) d,( 3. 0 ± 2. 0) d vs( 4. 3 ± 2. 2) d]( P < 0. 01),and the incidence of complications was reduced[7. 6%( 5/65) vs 20. 8%( 14/67) ]( P < 0. 05). Conclusion For early NSCLC patients,thoracoscopic pulmonary segmentectomy and lobectomy are safe and reliable,and compared with thoracoscopic lobectomy,thoracoscopic pulmonary segmentectomy can retain more healthy lung tissue,with less trauma and faster recovery.
引文
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[14]王俊,赵辉.亚肺叶切除治疗早期肺癌需要考虑的几个问题[J].中国肺癌杂志,2016,19(6):351-354.
[15] Srisomboon C,Koizumi K,Haraguchi S,et al. Complete video-assisted thoracoscopic surgery for lung cancer in 400 patients[J].Asian Cardiovasc Thorac Ann,2013,21(6):700-707.
[16]郑鑫林,夏学阳,张金周,等.胸腔镜下肺段切除与肺叶切除治疗临床I期非小细胞肺癌疗效对比的Meta分析[J].中国肺癌杂志,2016,26(10):854-860.
[17] Yoshimoto K,Nomori H,Mori T,et al. Quantification of the impact ofsegmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomo-graphy[J]. J Thorac Cardiviovasc Surg,2009,137(5):1200-1205.
[18] Kim SJ,Lee YJ,Park JS,et al. Changes in pulmonary function inlung cancer patinents after video-assisted thoracic surgery[J].Ann Thorac Surg,2015,99(1):210-217.
[19] Leshnower BG,Miller DL,Fernandez FG,et al. Video-assistedthoracoscpic surgery segmentectomy:A safe and effective proce-dure[J]. Ann Thorac Surg,2010,89(5):1571-1576.
[20]陈亮.全胸腔镜解剖性肺段切除术图谱[M].南京:东南大学出版社,2015:46-47.
[2] Chen I,Le GM,Noone AM,et al. Lung cancer incidence trends byhistology type among Asian American,Native Hawaiian,andPacific Islanderpopulations in the United States,1990-2010[J].Caner Epidemiol Biomarkers Prev,2014,23(11):2250-2265.
[3] Jheon S,Yang HC,Cho S. Video-assisted thoracic surgery for lungcancer[J]. Gen Thorac Cardiovasc Surg,2012,60(5):255-260.
[4] Meza R,Meernik C,Jeon J,et al. Lung cancer incidence trends bygender,raceand histology in the United States,1973-2010[J].PLo S One,2015,10(3):e0121323.
[5] Detterbeck FC,Boffa DJ,Kim AW,et al. The eighth edition lungcancer stage classifaction[J]. Chest,2017,151(1):193-203.
[6] Churchill ED,Belsey R. Segmental pneumonectomy in bronchiec-tasis:The lingula segment of the left upper lobe[J]. Ann Surg,1939,109(4):481-499.
[7] Murakami S,Watanabe Y,Shimizu J,et al. Second surgical interven-tion for contralateral recurrence or second primary lung cancer[J].Kyobu Geka,1989,42(9):722-726,discussion 726-728.
[8] Ginsberg RJ,Rubinstein LV. Randomized trial of lobectomyversus limited resection for T1N0non-small cell lung cancer.Lung cancer study group[J]. Ann Thorac Surg,1995,60(3):615-622,discussion 622-623.
[9] Landreneau RJ,Normolle DP,Christie NA,et al. Recurrence andsurvival outcomes after anatomic segementectomy versus lobec-tomy for clinical stageⅡnon-small-cell lung cancer:A propensitymatched analysis[J]. J Clin Oncol,2014,32(23):2449-2455.
[10] Ahorki NK,Yip R,Hanaoka T,et al. Sublobar resection is equivalentto lobectomyfor clinical stageⅠA lung cancer in solid nodules[J].J Thorac Cardiovasc Surg,2014,147(2):754-762.
[11] Yamashita S,Chujo M,Kawano Y,et al. Clinical impact of sege-mentectomy compared with lobectomy under complete video-assis-ted thoracic surgery in the treatment of stageⅠnon-small-celllung cancer[J]. J Surg Res,2011,166(1):46-51.
[12] Okada M,Nishio W,Sakamoto T,et al. Effect of tumor size onprognosis in patients with non-small cell lung cancer:The role ofsegmentectomy as a type of lesser resection[J]. J Thorac Cardio-vasc Surg,2005,129(1):87-93.
[13] Schuchert MJ,Pettiford BL,Keeley S,et al. Anatomic segmentec-tomy in the treatment of stageⅠnon-small cell lung cancer[J].Ann Thorac Surg,2007,84(3):926-932,discussion 932-933.
[14]王俊,赵辉.亚肺叶切除治疗早期肺癌需要考虑的几个问题[J].中国肺癌杂志,2016,19(6):351-354.
[15] Srisomboon C,Koizumi K,Haraguchi S,et al. Complete video-assisted thoracoscopic surgery for lung cancer in 400 patients[J].Asian Cardiovasc Thorac Ann,2013,21(6):700-707.
[16]郑鑫林,夏学阳,张金周,等.胸腔镜下肺段切除与肺叶切除治疗临床I期非小细胞肺癌疗效对比的Meta分析[J].中国肺癌杂志,2016,26(10):854-860.
[17] Yoshimoto K,Nomori H,Mori T,et al. Quantification of the impact ofsegmentectomy on pulmonary function by perfusion single-photon-emission computed tomography and multidetector computed tomo-graphy[J]. J Thorac Cardiviovasc Surg,2009,137(5):1200-1205.
[18] Kim SJ,Lee YJ,Park JS,et al. Changes in pulmonary function inlung cancer patinents after video-assisted thoracic surgery[J].Ann Thorac Surg,2015,99(1):210-217.
[19] Leshnower BG,Miller DL,Fernandez FG,et al. Video-assistedthoracoscpic surgery segmentectomy:A safe and effective proce-dure[J]. Ann Thorac Surg,2010,89(5):1571-1576.
[20]陈亮.全胸腔镜解剖性肺段切除术图谱[M].南京:东南大学出版社,2015:46-47.