全胸腔镜下非小细胞肺癌淋巴结清扫的对比研究

目的探讨全胸腔镜下非小细胞肺癌根治术中区域淋巴结清扫的可行性、安全性及临床价值。方法我院2009年10月～2011年12月对181例周围型非小细胞肺癌分别施行全胸腔镜（全胸腔镜组，n=77）及传统开胸（传统开胸组，n=104）肺癌根治术，比较2组术中清扫淋巴结数、转移的阳性淋巴结数、手术时间、术中出血量、术后第1天胸管引流量及术后带胸引管时间和住院时间等情况。结果2组患者无围手术期死亡，全胸腔镜组手术时间（13I．0±25．6）min，与传统开胸组（129．2±26．8）min比较无显著差异（t=0．455，P=0．649），术中出血量（140．8±110．6）ml与传统开胸组（148．1±96．8）ml比较无显著差异（t=-0．472，P=0．638），术后带胸引管时间（8．4±3．1）d与传统开胸组（8．2±2．3）d比较无统计学差异（t=0．498，P=0．619），术后住院时间（9．8±3．7）d与传统开胸组（10．6±2．1）d比较无统计学差异（t=-1．841，P=0．067），清扫淋巴结（20．1±7．7）枚与传统开胸组（18．9±5．6）枚比较无统计学差异（t=1．214，P=0．226）。全胸腔镜组术后第1天胸液量（260．9±111．9）ml，显著少于传统开胸组（322．8±103．6）ml（t=3．841，P=0．000）。术后近期复发率全胸腔镜组5．2％（4／77）与传统开胸组5．8％（6／104）无统计学差异（∥=0．000，P=1．000）。全胸腔镜组转移率6．5％（5／77）与传统开胸组8．6％（9／104）无统计学差异（x。=0．289，P=0．591）。结论全胸腔镜下肺癌根治术淋巴结清扫治疗周围型肺癌 安全、有效、可行，术后胸液量少，在淋巴结清扫的彻底性方面能达到常规开胸手术的效果。

A Comparative Study of Video-assisted Thoracoscopic Lymphadenectomy for Non-small Cell Lung Cancer

Objective To investigate the possibility, safety and clinical significance of video-assisted thoracoscopic thymectomy in regional lymphography. Methods From October 2009 to December 2011, 181 patients with peripheral non-small cell lung cancer（ NSCLC）, who underwent video-assisted thoracoscopic radical lobectomy （n = 77 ） or standard thoracotomy （n = 104） combined with systemic lymphadenectomy in our hospital, were enrolled into this study. The numbers of dissected and metastatic lymph nodes, operation time, blood loss, drainage volume, drainage time and hospitalization time were compared between the two groups. Results No patient died in both the groups. No significant differences were found between the two groups in operation time [（131.0~25.6） minvs. （129.2 ＋26.8） min, t=0.455, P=0.649], blood loss [（140.8~110.6） mlvs. （148.1 ±96.8） ml, t= -0.472, P=0.638], drainage time [（8.4±3.1） dvs. （8.2±2.3） d, t=0.498, P=0.619], hospitalization time [（9.8± 3.7） dvs. （10.6±2.1） d, t= -1.841, P=0.067], the number of removed lymph nodes [20.1 ±7.7 vs. 18.9±5.6, t= 1.214, P=O. 226],the rate of recurrence [5.2% （4/77） vs. 5.8% （6/104）,X2 =O. O00,P =1.000] and metastasis [6.5% （5/77） vs. 8.6% （9/104）, X2 =0. 289,P =0. 591]. Whereas we found significant difference between the two group in drainage volume [（260.9±111.9） ml vs. （322.8 ±103.6） ml, t =3. 841, P =0.000]. Conclusion Video-assisted thoracoscopic lobectomy and lymphadenectomy for peripheral lung cancer is a safe, effective and practicable procedure, which can produce equally comolete lvmoh node dissection and less drainage volume compared with standard thoracotomv.