Complete video-assisted thoracic surgery is favorable than thoracotomy for lobectomy on stage Ⅰ non small cell lung cancer

目的 与开胸肺叶切除对比,探讨全胸腔镜(VATS)下肺叶切除治疗早期肺癌的安全性和有效性.方法 回顾分析2002年1月至2008年1月接受肺叶切除的165例Ⅰ期非小细胞肺癌病人,VATS组41例,开胸组124例.对比两组术前、术中、术后近期情况.结果 两组在年龄、性别分布、术前主要合并症、肺功能、手术切除的肺叶、术后病理类型、分期等方面差异无统计学意义(P<0.05).VATS组与开胸组相比,手术时间(195±57)min对(224±54)min(P<0.05);术中出血(227±153)ml对(349±158)ml(P<0.05);淋巴结清扫组数4.1±1.3对4.5±1.5(P<0.05);术后胸引流总量(1595±1038)ml对(1828±1074)ml(P<0.05);术后肺炎发生率4.9%对12.1%(P<0.05);1年无瘤生存率Ⅰ A期均为100%,ⅠB期分别为90.0%和91.3%(P>0.05);住院费用(4.6±1.1)万元对(3.5±1.1)万元.结论 两种术式在治疗早期肺癌具有相似的完全性和彻底性,VATS肺叶切除术较开胸肺叶切除术的手术时间略短,术中出血略少,术后肺炎发生率略低,但平均住院费用略高.Objective To compare the results and safety between video-assisted thoracic surgery (VATS) lobectomy and conv-antional lobectomy via open theracotomy in patients with stage Ⅰ non small cell lung cancer (NSCLC). Methods Retrospectively re-viewed 165 patients with stage Ⅰ NSCLC underwent either VATS lobectomy (VATS group, n=41) or standard lobectomy via thora-cotomy (open group, n = 124) from January 2002 to December 2007. Patients' operative characteristics and postoperative courseswere comparable between two groups. Results The operative time was ( 195 ~ 57)rain in the VATS group and (224±64)min in theopen group ( P < 0.05). The blood loss was (227±153) ml and (349 ~ 158 ) ml, respectively ( P < 0.05). The group number of me-diastinal lymphonode resection was 4.1±1.3 and 4.5±1.5 ( P > 0.05). The postoperative chest tube drainage was ( 1595±1038 )ml and (1828±1074)ml (P>0.05). The postoperative pneumonia rate was 4.9% and 12.1% (P <0.05). One-year tumor freesurvival rate for stage Ⅰ B patients in VATS and open group wasg0.9% and91.3% (P>0.05)respectively, and for stage Ⅰ A pa-tiants in both groups was 100%. Conclusion Compare with thoracotomy, VATS lobectomy for patients with stage Ⅰ NSCLC appearsto be as effective but less morbid.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)03152-1552