VATS解剖性肺段切除术与肺叶切除术治疗Ⅰ_a期NSCLC患者的手术情况及对肺功能影响的比较
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摘要
目的:探讨电视胸腔镜(VATS)解剖性肺段切除术与肺叶切除术治疗I_a期非小细胞肺癌(NSCLC)患者的手术情况及对患者肺功能的影响。方法:选取我院手术治疗的Ⅰ_a期NSCLC患者,收集时间2014年1月至2016年12月,根据术式不同分为两组,均采用VATS手术治疗,A组(54例)患者采用解剖性肺段切除术、B组(60例)采用肺叶切除术治疗,对比两组患者的手术效果及术后肺功能变化。结果:A组患者的手术时间、清扫淋巴结数目与B组比较差异无统计学意义(P>0.05);A组患者的手术出血量、术后胸腔引流量、术后拔管时间、术后住院时间均显著的低于B组患者(P<0.05);术前,A组和B组患者的FEV1%、FVC%、MVV%测定值差异无统计学意义(P>0.05),术后3个月复查,A组患者的FEV1%、FVC%、 MVV%测定值均显著高于B组患者(P<0.05);手术后,A组患者的并发症发生率(7.41%)低于B组患者(13.33%),但是差异无统计学意义(P>0.05)。结论:VATS解剖性肺段切除术治疗Ⅰ_a期NSCLC患者具有手术创伤小、术后恢复快、对患者肺功能影响更小的优势。
Objective:To investigate the surgical situation and the effect of pulmonary function between video-assisted thoracoscopy(VATS) anatomic segmental resection and lobectomy for the treatment of non-small cell lung cancer(NSCLC) patients in stage I_a.Methods:The patients with stage Ⅰ_a NSCLC treated in our hospital from January 2014 to December 2016 were collected.Two groups of patients were treated with VATS surgery.A group(54 cases) was treated with anatomic segmentectomy,B group(60 patients) with lobectomy.Pulmonary function changes and the effect of the operation of the two groups were compared.Results:The operation time and number of lymph node between A and B group had no significant difference(P>0.05),and surgery hemorrhage,thoracic drainage volume,postoperative extubation time,postoperative hospitalization time in A group were significantly lower than B group(P<0.05).Before operation,FEV1%,FVC%,MVV% had no statistically significant difference between the two groups(P>0.05).3 months after surgery,FEV1%,FVC%,MVV% in A group was significantly higher than in B group(P<0.05).After the surgery,the complication rate in the A group was 7.41%,which was lower than that of B group(13.33%).But there was no statistically significant difference(P>0.05).Conclusion:VATS dissection for NSCLC patients with stage I_a has the advantages of small surgical trauma,rapid postoperative recovery and less impact on the pulmonary function of the patients.
Objective:To investigate the surgical situation and the effect of pulmonary function between video-assisted thoracoscopy(VATS) anatomic segmental resection and lobectomy for the treatment of non-small cell lung cancer(NSCLC) patients in stage I_a.Methods:The patients with stage Ⅰ_a NSCLC treated in our hospital from January 2014 to December 2016 were collected.Two groups of patients were treated with VATS surgery.A group(54 cases) was treated with anatomic segmentectomy,B group(60 patients) with lobectomy.Pulmonary function changes and the effect of the operation of the two groups were compared.Results:The operation time and number of lymph node between A and B group had no significant difference(P>0.05),and surgery hemorrhage,thoracic drainage volume,postoperative extubation time,postoperative hospitalization time in A group were significantly lower than B group(P<0.05).Before operation,FEV1%,FVC%,MVV% had no statistically significant difference between the two groups(P>0.05).3 months after surgery,FEV1%,FVC%,MVV% in A group was significantly higher than in B group(P<0.05).After the surgery,the complication rate in the A group was 7.41%,which was lower than that of B group(13.33%).But there was no statistically significant difference(P>0.05).Conclusion:VATS dissection for NSCLC patients with stage I_a has the advantages of small surgical trauma,rapid postoperative recovery and less impact on the pulmonary function of the patients.
引文
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[14] Mao Xiaoliang,Tong Jichun,Zhu Zheng,et al.Thoracoscopic anatomical lung segmentectomy for stage Ⅰa non-small cell lung cancer(report of 6 cases)[J].Journal of Practical Clinical Medicine,2015,19(24):76-77.
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[16] Feng Haiming,Zhao Ye,Ma Jianxing,et al.Meta-analysis of the effect of different surgical methods on postoperative pulmonary function in patients with early non-small cell lung cancer[J].Chinese Journal of Evidence-Based Medicine,2017,17(8):949-958.
[17] Liu Yang,Zhong Shengyi,He Qihua,et al.Comparison of prognosis between VATS lobectomy and sublobectomy for stage I lung adenocarcinoma[J].Chinese Journal of Lung Cancer,2017,20(1):47-54.[刘洋,钟声逸,何绮华,等.Ⅰ期肺腺癌VATS肺叶切除与亚肺叶切除预后比较[J].中国肺癌杂志,2017,20(1):47-54.]
[18] Zhu Guoxi.Thoracoscopic lobectomy and anatomical segmentectomy for stage I lung cancer[J].Henan Medical Research,2017,26(5):901-902.
[19] Han Wei,Qiao Xueying.Disputes and progress in the treatment of stage Ⅲa-N2 NSCLC[J].Chinese Journal of Radiation Oncology,2017,26(4):470-473.
[20] Wu Yingmeng,Huang Weizhao,Jiang Haiming.Thoracoscopic sublobar resection and mediastinal lymph node sampling for early non-small cell lung cancer[J].Guangdong Medical Journal,2013,34(8):1203-1204.
[21] Li D,Zhu X,Wang H,et al.Association between PD-L1 expression and driven gene status in NSCLC:A Meta-analysis[J].European Journal of Surgical Oncology,2017,43(7):1372.
[22] Eguchi S,Kanematsu T,Arii S,et al.Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey[J].Surgery,2008,143(4):469-475.
[2] Pang Wenguang,Huang Fengliu,Ye Min,et al.Prospective study of total endoscopic segmental lung resection versus lobectomy in the treatment of early lung cancer[J].Journal of Clinical Lung,2017,22(10):1874-1878.[庞文广,黄凤柳,叶敏,等.全腔镜解剖性肺段切除术对比肺叶切除术在治疗早期肺癌的前瞻性研究[J].临床肺科杂志,2017,22(10):1874-1878.]
[3] Liu Shixue,Wang Jun,Xu Meiqing,et al.Clinical analysis of 41 cases of total thoracoscopic segmentectomy[J].Chinese Journal of Minimally Invasive Surgery,2016,16(12):1127-1130.[刘士学,王君,徐美清,等.全胸腔镜下解剖性肺段切除41例临床分析[J].中国微创外科杂志,2016,16(12):1127-1130.]
[4] Qiao Yulei,Lin Zongwu,Xi Junjie,et al.Thoracoscopic anatomical lung segmentectomy for clinical stage Ⅰ lung cancer[J].Chinese Journal of Cancer,2015,25(8):619-623.[乔玉磊,林宗武,奚俊杰,等.胸腔镜解剖性肺段切除术治疗临床Ⅰ期肺癌[J].中国癌症杂志,2015,25(8):619-623.]
[5] Zhong Bin,Wu Qiyong,Tong Jichun,et al.A comparative study of thoracoscopic segmental or lobectomy for ground glass nodules[J].Chinese Journal of Minimally Invasive Surgery,2017,17(1):62-64.[钟斌,吴奇勇,童继春,等.胸腔镜肺段或肺叶切除术治疗肺磨玻璃结节的比较研究[J].中国微创外科杂志,2017,17(1):62-64.]
[6] Shao Feng,Yang Rusong,Liu Zhengcheng,et al.Clinical and pathological features of video-assisted thoracoscopic resection of subcentimeter non-small cell lung cancer[J].Journal of Clinical and Pathology,2017,37(1):86-90.
[7] Wu Guodong,Zhang Yi,Qian Kun,et al.Short-term results of thoracoscopic segmental lung resection for stage Ia non-small cell lung cancer over 60 years old[J].Chinese Journal of Minimally Invasive Surgery,2017,17(1):15-18.
[8] Wang Junfeng,Fu Yudong,Kan Qiangbo,et al.Thoracoscopic anatomical lung segmentectomy in 30 cases[J].Chinese Journal of Minimally Invasive Surgery,2016,16(11):1013-1015.[王俊峰,付玉东,阚强波,等.全胸腔镜解剖性肺段切除术30例[J].中国微创外科杂志,2016,16(11):1013-1015.]
[9] Lin Ling,Zhao Heng.Application of intentional thoracoscopic anatomical segmentectomy in early lung cancer[J].Journal of Clinical Surgery,2017,25(7):495-497.[林凌,赵珩.意向性胸腔镜下解剖性肺段切除在早期肺癌中的应用[J].临床外科杂志,2017,25(7):495-497.]
[10] Zhi Xiuyi,Li Hui.Anatomical lung resection for early non-small cell lung cancer[J].Chinese Journal of Surgery,2015,53(10):794-797.[支修益,李辉.解剖性肺段切除治疗早期非小细胞肺癌[J].中华外科杂志,2015,53(10):794-797.]
[11] Gao Shugeng,Qiu Bin,Li Fang,et al.Comparison of short-term outcomes between thoracoscopic partial lobectomy and lobectomy for pT1aN0M0 peripheral non-small cell lung cancer[J].Chinese Journal of Surgery,2015,53(10):727-730.
[12] She Xiaowei,Gu Yunbin,Xu Chun,et al.3D-CTBA and 3D-VATS single-port segmentectomy for non-small cell lung cancer[J].Chinese Journal of Lung Cancer,2017,20(9):598-602.
[13] Xu Xiaofang,Liu Jinshi.Clinical analysis of 30 cases of non-small cell lung cancer treated by single-hole thoracoscopic segmental resection[J].Journal of Oncology,2017,23(7):606-609.[徐小方,刘金石.单孔胸腔镜下解剖性肺段切除术30例非小细胞肺癌临床分析[J].肿瘤学杂志,2017,23(7):606-609.]
[14] Mao Xiaoliang,Tong Jichun,Zhu Zheng,et al.Thoracoscopic anatomical lung segmentectomy for stage Ⅰa non-small cell lung cancer(report of 6 cases)[J].Journal of Practical Clinical Medicine,2015,19(24):76-77.
[15] Zhang Yanjiao,Gao Yushun,Mao Yousheng,et al.Effect of thoracoscopic segmental lung resection on pulmonary function in stage I a non-small cell lung cancer[J].Journal of Oncology,2016,22(5):389-393.
[16] Feng Haiming,Zhao Ye,Ma Jianxing,et al.Meta-analysis of the effect of different surgical methods on postoperative pulmonary function in patients with early non-small cell lung cancer[J].Chinese Journal of Evidence-Based Medicine,2017,17(8):949-958.
[17] Liu Yang,Zhong Shengyi,He Qihua,et al.Comparison of prognosis between VATS lobectomy and sublobectomy for stage I lung adenocarcinoma[J].Chinese Journal of Lung Cancer,2017,20(1):47-54.[刘洋,钟声逸,何绮华,等.Ⅰ期肺腺癌VATS肺叶切除与亚肺叶切除预后比较[J].中国肺癌杂志,2017,20(1):47-54.]
[18] Zhu Guoxi.Thoracoscopic lobectomy and anatomical segmentectomy for stage I lung cancer[J].Henan Medical Research,2017,26(5):901-902.
[19] Han Wei,Qiao Xueying.Disputes and progress in the treatment of stage Ⅲa-N2 NSCLC[J].Chinese Journal of Radiation Oncology,2017,26(4):470-473.
[20] Wu Yingmeng,Huang Weizhao,Jiang Haiming.Thoracoscopic sublobar resection and mediastinal lymph node sampling for early non-small cell lung cancer[J].Guangdong Medical Journal,2013,34(8):1203-1204.
[21] Li D,Zhu X,Wang H,et al.Association between PD-L1 expression and driven gene status in NSCLC:A Meta-analysis[J].European Journal of Surgical Oncology,2017,43(7):1372.
[22] Eguchi S,Kanematsu T,Arii S,et al.Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey[J].Surgery,2008,143(4):469-475.