[1]王少东,李晓,隋锡朝,等.胸腔镜与开胸全肺切除治疗非小细胞肺癌的疗效比较[J].中国微创外科杂志,2017,17(10):882-886.
 Wang Shaodong,Li Xiao,Sui Xizhao,et al.Comparison of Thoracoscopic and Thoracotomic Pneumonectomy for Non-small Cell Lung Cancer[J].Chinese Journal of Minimally Invasive Surgery,2017,17(10):882-886.
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胸腔镜与开胸全肺切除治疗非小细胞肺癌的疗效比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
17
期数:
2017年10期
页码:
882-886
栏目:
临床研究
出版日期:
2017-10-20

文章信息/Info

Title:
Comparison of Thoracoscopic and Thoracotomic Pneumonectomy for Non-small Cell Lung Cancer
作者:
王少东李晓隋锡朝李运姜冠潮王俊**
北京大学人民医院胸外科,北京100044
Author(s):
Wang Shaodong Li Xiao Sui Xizhao et al.
Department of Thoracic Surgery, Peking University People’s Hospital, Beijing 100044, China
关键词:
肺癌全肺切除术胸腔镜手术开胸手术
Keywords:
Lung cancerPneumonectomyVideo-assisted thoracoscopic surgeryThoracotomy
文献标志码:
A
摘要:
目的探讨胸腔镜与开胸全肺切除在非小细胞肺癌治疗中的安全性、彻底性及中期疗效。方法回顾性分析2009年1月~2016年12月69例非小细胞肺癌行全肺切除的资料,其中24例行胸腔镜手术,45例行传统开胸手术。胸腔镜组男性较少[66.7%(16/24) vs. 93.3%(42/45), χ2=6.435,P=0.011],新辅助化疗比例较少[16.7%(4/24) vs. 40.0%(18/45), χ2=3.924,P=0.048],2组年龄、吸烟史、肿瘤位置和直径、术前合并症、新辅助放疗、病理类型、TNM分期均无显著性差异(P>0.05)。比较2组手术情况、术后并发症,以及1年、3年无复发生存率和总生存率。结果2组在纵隔淋巴结清扫站数和个数、淋巴结病理阳性个数、术后住院时间、术后并发症方面差异均无统计学意义(P>0.05),胸腔镜组手术时间短[中位数200(120~300)min vs. 240(120~360)min,Z=-2.278,P=0.023],术中出血少[100(20~600)ml vs. 300(50~1500)ml,Z=-3.088,P=0.002],术后引流时间短[1(1~2)d vs. 1(1~7)d,Z=-2.066,P=0.039]。中位随访时间19(3~63)个月,胸腔镜组术后1年、3年无复发生存率分别为80%、43.2%,开胸组为84.1%、36.3%,2组无显著性差异(log-rank χ2=0.765,P=0.382)。胸腔镜组1年、3年生存率分别为84.4%、70.1%,开胸组为79.8%、42.5%,2组无显著性差异(log-rank χ2=2594,P=0.107)。结论全肺切除治疗非小细胞肺癌,胸腔镜与开胸手术具有同样的安全、彻底性,两者中期生存相当。胸腔镜全肺切除具有手术时间短、术中出血少、术后带管时间短的优势。
Abstract:
ObjectiveTo evaluate the safety, feasibility and mid-term efficacy of video-assisted thoracoscopic surgery (VATS) pneumonectomy for non-small cell lung cancer (NSCLC).MethodsFrom January 2009 to December 2016, 69 patients who underwent pnumonectomy for NSCLC were reviewed, among which 24 patients underwent thoracoscopical pneumonectomy and 45 patients underwent open thoracotomy. The VATS group had less male patients [66.7% (16/24) vs. 93.3% (42/45), χ2=6.435, P=0.011] and lower neoadjuvant chemotherapy rate [16.7% (4/24) vs. 40.0% (18/45), χ2=3.924, P=0.048].There were no significant differences in age, smoking history, tumor location and diameter, neoadjuvant radiation, pathology type, and TNM staging between the two groups (P>0.05). Surgery condition, postperative complications, overall survival and recurrence free survival were compared between the two groups. ResultsThere were no significant differences in mediastinal lymph nodes dissected, positive lymph nodes, hospital stay, and postoperative complications between the two groups (P>0.05). The surgery time and operative blood loss were less in the VATS group than those in the thoracotomy group [median: 200 (120-300) min vs. 240 (120-360) min, Z=-2.278, P=0.023; 100 (20-600) ml vs. 300 (50-1500) ml, Z=-3.088, P=0.002]. The postoperative drainage time in the VATS group was also shorter than that in the thoracotomy group [1 (1-2) days vs. 1 (1-7) days, Z=-2.066, P=0.039]. The median follow-up time was 19 (3-63) months. The one-year recurrence-free survival rate was 80% in the VATS group and 841% in the thoracotomy group, and three-year recurrence-free survival rate was 43.2% and 36.3%, respectively (log-rank χ2=0765, P=0.382). The one-year overall survival rate was 84.4% in the VATS group and 79.8% in the thoracotomy group, and the three-year overall survival rate was 70.1% and 42.5%, respectively (log-rank χ2=2.594, P=0.107).ConclusionFor NSCLC, VATS pneumonectomy is a feasible procedure with less operative blood loss, shorter surgery time and postoperative drainage time, with its surgical and oncologic outcomes comparable to that of thoracotomy pneumonectomy.

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备注/Memo

备注/Memo:
基金项目:北京市科技计划(D1411000000214004)**通讯作者,E-mail:jwangmd@yahoo.com
更新日期/Last Update: 2018-01-11