全胸腔镜与胸腔镜辅助肺叶切除术治疗合并COPD的非小细胞肺癌

目的探讨全胸腔镜与胸腔镜辅助肺叶切除术治疗合并COPD的老年非小细胞肺癌的临床疗效。方法从我院2010年1月～2014年6月手术治疗的合并COPD老年非小细胞肺癌患者中,随机选取全胸腔镜肺叶切除术（CVATS组）和胸腔镜辅助小切口肺叶切除术（VAMT组）患者各30例,对两组围术期临床指标及并发症的发生情况进行分析对比。结果两组患者的年龄、性别、切除肺叶总数、术前COPD程度、术后病理类型及病理分期情况对比,差异均无统计学意义（P〉0.05）;CVATS组在胸管留置时间、住院时间、镇痛剂使用时间、切口长度、机械通气时间、术后吸氧时间方面较VAMT组均明显减少,差异有统计学意义（P〈0.05）;术中出血量、手术时间比较两组无显著差别（P〉0.05）;CVATS组和VAMT组平均每例患者清扫淋巴结数目分别为（19.45±6.56）枚和（21.53±6.35）枚,差异无统计学意义（P〉0.05）;CVATS组术后心律失常、切口慢性疼痛、肺不张的发生率较VAMT组均明显减少,肺部感染、肺漏气、切口愈合不良的发生率也较VAMT组低,两组总的并发症发生率分别为13.33%和36.67%,差异有统计学意义（P〈0.05）。结论全胸腔镜下肺叶切除术治疗合并COPD的老年非小细胞肺癌更安全,临床疗效更显著,可作为该类患者的首选治疗方法。

Treatment of non-small cell lung cancer merger of COPD using complete video-assisted thoracoscopic and video-assisted minithoracotomy pneumonectomy

Objective To make a comparative of clinical results of CVATS（complete video-assisted thoracoscopic pneumonectomy） and VAMT（video-assisted minithoracotomy pneumonectomy） treatment of elderly non-small cell lung cancer patients merger of COPD（chronic obstructive pulmonary disease）. Methods Among the operation patients in Nanjing Hospital Affiliated to Nanjing Medical University between January 2010 and June 2014,30 elderly non-small cell lung cancer patients merger of COPD were randomly entered into CVATS group and VAMT group, to compare Clinical indicators and The occurrence of complications. Results Comparison of two groups of patients＇ age,gender,total removal of the lung,preoperative degree of COPD,postoperative pathological type and pathological staging,there were no statistically significant difference（P〉0.05）;The chest tube indwelling time,hospitalization time,analgesic use time,incision length,mechanical ventilation time and postoperative oxygen time in CVATS group were significantly reduced than in the VAMT group（P〈0.05）;Intraoperative blood loss,operating time to compare two groups had no significant difference（P0.05）;The number of cleaning lymph nodes on average every patients in two groups was respectively（19.45±6.56） and（21.53±6.35）,and there was no statistically significant difference（P〉0.05）;Two groups of the total complication rate were 13.33% and 36.67% respectively（P〈0.05）,incidence of postoperative arrhythmia,chronic pain of incision and the atelectasis in CVATS group were significantly reduced than in VAMT group,and the incidence of pulmonary infection and pulmonary air leakage was also reduced. Conclusion CVATS treatment of elderly non-small cell lung cancer patients merger of COPD is more safety, clinical curative effect is more significant, can be used as the preferred treatment of these patients.