全胸腔镜肺癌根治术淋巴结清扫的探讨

目的探讨全胸腔镜下肺叶切除治疗临床Ⅰ期非小细胞肺癌淋巴结清扫的安全性和可行性。方法 2006年1月～2008年12月,160例临床Ⅰ期非小细胞肺癌接受全腔镜下肺叶切除术、纵隔淋巴结清扫,采用不撑开肋骨三孔法,并与同期247例接受常规开放手术的Ⅰ期非小细胞肺癌进行比较。结果胸腔镜组淋巴结清扫组数(2.4±1.5)组与开胸组(2.6±1.6)组无显著差异(t=1.262,P=0.208),胸腔镜组清扫淋巴结(9.8±6.2)枚,与开胸组(9.9±5.9)枚无统计学差异(t=-0.160,P=0.873)。开胸组并发症发生率11.7%(29/247)和围手术期死亡率2.8%(7/247)与胸腔镜组并发症发生率9.4%(15/160)和围手术期死亡率0.6%(1/160)无显著差异(χ2=0.564,P=0.453;χ2=1.446,P=0.229)。胸腔镜组生存情况优于开胸组(χ2=5.373,P=0.020)。结论全胸腔镜肺叶切除术治疗临床Ⅰ期非小细胞肺癌在技术上是安全可行的,其淋巴结清扫可达到开放手术的范围,远期疗效不亚于开放手术。

Complete Video-assisted Thoracoscopic Surgery versus Open Mediastinal Lymphadenectomy for Non-small Cell Lung Cancer

Objective To evaluate the safety and feasibility of video-assisted thoracoscopic surgery （VATS） for lobectomy in patients with stage Ⅰ non-small cell lung cancer. Methods We retrospectively analyzed the clinical data of 160 patients with stage Ⅰ non-small cell lung cancer, who underwent VATS for lobectomy and mediastinal lymphadenectomy in our hospital, from January 2006 to December 2008. Another 247 patients with stage Ⅰ non-small cell lung cancer, who underwent open surgery during the same period, were set as a control group. Results No significant difference existed between the VATS and control groups in the numbers of removed lymph node groups and lymph nodes [2.4± 1.5 and 9.8 ±6.2 vs. 2.6 ±1.6 and 9.9 ±5.9; t = 1. 262, P =0. 208 and t= -0. 160, P =0. 873, respectively], or the rates of complications and perioperative mortality [9.4% （15/160） and 0.6% （1/160） vs. 11.7% （29/247） and 2.8% （7/247） , χ2 = 0. 564, P = 0. 453 and χ2 = 1. 446, P = 0. 229, respectively ]. However, the VATS group had a higher survival rate than the control group （χ2 = 5. 373, P = 0. 020）. Conclusions VATS is safe and feasible for lobectomy and mediastinal lymphadenectomy in patients with stage Ⅰ non-small cell lung cancer, and is effective as open surgery in the scope of lymphadenectomy. Its long-term efficacy is as good as open surgery.