单孔胸腔镜和单操作孔胸镜能有效治疗非小细胞肺癌
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摘要
为比较单孔胸腔镜、单操作孔胸镜和传统肺癌根治术治疗非小细胞肺癌的临床疗效和生存期差异,本研究采用随机数字表法将173例非小细胞肺癌患者分为A组(n=57例)、B组(n=58例)和C组(n=58例)。A组采用开胸肺癌根治术治疗,B组采用单操作孔胸腔镜下肺癌根治术治疗,C组采用单孔胸腔镜下肺癌根治术治疗。通过观察3组患者近期疗效和远期生存差异,本研究发现B组和C组患者术中出血量、术后引流量、引流管放置时间、手术时间、住院时间均显著低于A组(p<0.05);B组和C组患者术后1 d、3 d和7 d的VAS评分均显著低于A组(p<0.05),且C组患者术后1 d、3 d和7 d的VAS评分显著低于B组(p<0.05);3组患者中位OS、3年生存率、5年生存率相比较差异均无统计学意义(p>0.05)。因此,本研究的初步结论为:单孔胸腔镜手术治疗早期非小细胞肺癌可获得与单操作孔胸腔镜手术及开胸手术相同的近期疗效和远期生存效果,且可减少创伤,降低术后疼痛感,有利于术后恢复和治疗,值得临床推广应用。
To compare the clinical efficacy and survival dif ferences of single-port VATS, single-operated-port VATS and traditional radical resection of lung cancer in the treatment of non-small cell lung cancer, 173 patients with non-small cell lung cancer were divided into A group(n=57 cases), B group(n=58 cases) and C group(n=58 cases) with random number table. Group A was treated with traditional thoraco-tomy for lung cancer. Group B was treated with single-operation-port VATS, and group C was treated with single-port VATS. By observing the short-term efficacy and long-term survival differences of the three groups, this research found that the operation time, intraoperative bleeding volume, drainage tube placement time, postoperative drainage volume and hospitalization time in group B and group C were significantly lower than those in group A(p<0.05); the VAS scores of group B and group C were significantly lower than those of group A at 1 day, 3 days and 7 days after operation(p<0.05), and the VAS scores of group C were significantly lower than those of group B at 1 day, 3 days and 7 days after operation(p<0.05). There were no significant differences in median OS, 3-year survival rate, and 5-year survival rate between the 3 groups(p>0.05). Therefore, the preliminary conclusion of this study was that single-port VATS for early non-small cell lung cancer could achieve the same short-term and long-term survival effects as single-operation-port VATS and thoracotomy, could reduce trau ma and postoperative pain and would be also beneficial to postoperative recovery and treatment, which would be worthy of clinical application.
To compare the clinical efficacy and survival dif ferences of single-port VATS, single-operated-port VATS and traditional radical resection of lung cancer in the treatment of non-small cell lung cancer, 173 patients with non-small cell lung cancer were divided into A group(n=57 cases), B group(n=58 cases) and C group(n=58 cases) with random number table. Group A was treated with traditional thoraco-tomy for lung cancer. Group B was treated with single-operation-port VATS, and group C was treated with single-port VATS. By observing the short-term efficacy and long-term survival differences of the three groups, this research found that the operation time, intraoperative bleeding volume, drainage tube placement time, postoperative drainage volume and hospitalization time in group B and group C were significantly lower than those in group A(p<0.05); the VAS scores of group B and group C were significantly lower than those of group A at 1 day, 3 days and 7 days after operation(p<0.05), and the VAS scores of group C were significantly lower than those of group B at 1 day, 3 days and 7 days after operation(p<0.05). There were no significant differences in median OS, 3-year survival rate, and 5-year survival rate between the 3 groups(p>0.05). Therefore, the preliminary conclusion of this study was that single-port VATS for early non-small cell lung cancer could achieve the same short-term and long-term survival effects as single-operation-port VATS and thoracotomy, could reduce trau ma and postoperative pain and would be also beneficial to postoperative recovery and treatment, which would be worthy of clinical application.
引文
Zhang R.F.,Zhang Y.,Wen F.B.,Wu K.,and Zhao S.,2016,Analysis of pathological types and clinical epidemiology of6,058 patients with lung cancer,Zhongguo Aizheng Zazhi(Chinese Journal of Lung Cancer),19(3):129-135(张仁锋,张岩,温丰标,吴恺,赵松,2016,6 058例肺癌患者病理类型和临床流行病学特征的分析,中国肺癌杂志,19(3):129-135)
Pompili C.,Franks K.N.,Brunelli A.,Hussain Y.S.,Holch P.,Callister M.E.,Robson J.M.,Papagiannopoulos K.,and Velikova G.,2017,Patient reported outcomes following video assisted thoracoscopic(VATS)resection or stereotactic ablative body radiotherapy(SABR)for treatment of non-small cell lung cancer:protocol for an observational pilot study(LiLAC),J.Thorac.Dis.,9(8):2703-2713
Wang X.,Wang L.,Zhang H.,Li K.,and Gong X.N.,2016,Feasibility and application of single-hole video-assisted thoracoscope in pulmonary peripheral tumors,Oncol.Lett.,12(6):4957-4960
Han X.Q.,Lei Y.Y.,Zeng B.,Zhang S.S.,Zou D.W.,Zhang X.,Gu Y.,Zou J.Y.,Su C.H.,and Luo H.H.,2017,Clinical research of single incision VATS,single utility port VATS and conventional three portal VATS in radical resection of lung cancer,Redai Yixue Zazhi(Journal of Tropical Medicine),17(5):569-573(韩向前,雷艺炎,曾博,张水深,邹大威,张昕,顾勇,邹健勇,苏春华,罗红鹤,2017,单孔,单操作孔与三孔胸腔镜肺癌根治术的临床研究,热带医学杂志,17(5):569-573)
Yang Z.,Shen Z.H.,Zhou Q.H.,Yang Z.,Shen Z.,Zhou Q.,and Huang Y.C.,2017,Single-incision versus multiport video-assisted thoracoscopic surgery in the treatment of lung cancer:a systematic review and meta-analysis,Acta Chir.Belg.,21:1-9
Pu Q.,Huang Y.C.,Lu Y.R.,Peng Y.,Zhang J.,Feng G.L.,Wang C.G.,Liu L.X.,and Dai Y.,2016,Tissue-specific and plasma microRNA profiles could be promising biomarkers of histological classification and TNM stage in non-small cell lung cancer,Thorac.Cancer,7(3):348-754
Smith C.B.,Wolf A.,Mhango G.,and Wisnivesky J.P.,2017,Impact of surgeon volume on outcomes of older stage I lung cancer patients treated via video-assisted thoracoscopic surgery,Semin.Thorac.Cardiovasc.Surg.,29(2):223-230
Yan X.,Chen X.,Li G.,and Chen S.,2017,Two-portal versus three-port video-assist thoracoscopic surgery for early stage nonsmall cell lung cancer:a retrospective study,Medicine(Baltimore),96(33):e7796
Chen H.,Xu G.,Zheng B.,Zheng W.,Zhu Y.,Guo Z.,and Chen C.,2016,Initial experience of single-port video-assisted thoracoscopic surgery sle e ve lobectomy and systematic mediastinal lymphadenectomy for non-small-cell lung cancer,J.Thorac.Dis.,8(8):2196-2202
Damian E.D.,and Shulman M.,201 0,Current status of thermal ablation treatments for lung malignancies,Semin.Intervent.Radiol.,27(3):268-275
Pompili C.,Franks K.N.,Brunelli A.,Hussain Y.S.,Holch P.,Callister M.E.,Robson J.M.,Papagiannopoulos K.,and Velikova G.,2017,Patient reported outcomes following video assisted thoracoscopic(VATS)resection or stereotactic ablative body radiotherapy(SABR)for treatment of non-small cell lung cancer:protocol for an observational pilot study(LiLAC),J.Thorac.Dis.,9(8):2703-2713
Wang X.,Wang L.,Zhang H.,Li K.,and Gong X.N.,2016,Feasibility and application of single-hole video-assisted thoracoscope in pulmonary peripheral tumors,Oncol.Lett.,12(6):4957-4960
Han X.Q.,Lei Y.Y.,Zeng B.,Zhang S.S.,Zou D.W.,Zhang X.,Gu Y.,Zou J.Y.,Su C.H.,and Luo H.H.,2017,Clinical research of single incision VATS,single utility port VATS and conventional three portal VATS in radical resection of lung cancer,Redai Yixue Zazhi(Journal of Tropical Medicine),17(5):569-573(韩向前,雷艺炎,曾博,张水深,邹大威,张昕,顾勇,邹健勇,苏春华,罗红鹤,2017,单孔,单操作孔与三孔胸腔镜肺癌根治术的临床研究,热带医学杂志,17(5):569-573)
Yang Z.,Shen Z.H.,Zhou Q.H.,Yang Z.,Shen Z.,Zhou Q.,and Huang Y.C.,2017,Single-incision versus multiport video-assisted thoracoscopic surgery in the treatment of lung cancer:a systematic review and meta-analysis,Acta Chir.Belg.,21:1-9
Pu Q.,Huang Y.C.,Lu Y.R.,Peng Y.,Zhang J.,Feng G.L.,Wang C.G.,Liu L.X.,and Dai Y.,2016,Tissue-specific and plasma microRNA profiles could be promising biomarkers of histological classification and TNM stage in non-small cell lung cancer,Thorac.Cancer,7(3):348-754
Smith C.B.,Wolf A.,Mhango G.,and Wisnivesky J.P.,2017,Impact of surgeon volume on outcomes of older stage I lung cancer patients treated via video-assisted thoracoscopic surgery,Semin.Thorac.Cardiovasc.Surg.,29(2):223-230
Yan X.,Chen X.,Li G.,and Chen S.,2017,Two-portal versus three-port video-assist thoracoscopic surgery for early stage nonsmall cell lung cancer:a retrospective study,Medicine(Baltimore),96(33):e7796
Chen H.,Xu G.,Zheng B.,Zheng W.,Zhu Y.,Guo Z.,and Chen C.,2016,Initial experience of single-port video-assisted thoracoscopic surgery sle e ve lobectomy and systematic mediastinal lymphadenectomy for non-small-cell lung cancer,J.Thorac.Dis.,8(8):2196-2202
Damian E.D.,and Shulman M.,201 0,Current status of thermal ablation treatments for lung malignancies,Semin.Intervent.Radiol.,27(3):268-275