胸腔镜下切除术与传统开胸术对肺叶切除术中发现微小淋巴结转移患者预后的影响比较

【目的】探讨胸腔镜下切除术与传统开胸术对于肺叶切除术中发现微小淋巴结转移（N2期）患者的预后影响，为临床治疗提供参考。【方法】共纳入非小细胞肺癌行肺叶切除术患者60例，且术中发现微小淋巴结转移的患者。根据不同术式分为观察组与对照组。观察组30例给予胸腔镜下切除治疗，对照组30例行传统开胸手术治疗。观察比较两组患者手术失血量、手术时间、引流量、住院时间等的差异。并随访3年比较生存率。【结果】观察组的手术失血量、手术时间、胸腔引流量、引流时间及住院时间均明显低于或少于对照组，两组比较差异均有显著性（P ＜0．05）。两组间淋巴结清扫数与淋巴结转移清扫数比较差异无显著性（P＞0．05）。与对照组相比，观察组肺不张发生率明显较低（ P＞0．05）。观察组患者1年生存率86．7％，3年生存率56．7％，平均生存时间（35．43＆#177;3．54）个月均高于对照组1年生存率63．3％，3年生存率30．0％，平均生存时间（32．74＆#177;3．25）个月，且两组相比较差异比较均有显著性（ P ＜0．05）。【结论】与传统开胸手术相比，胸腔镜下行肺叶切除术治疗N2期非小细胞肺癌具有创伤小、出血少、手术时间短、恢复快及并发症少等优点，同时可以有效延长患者术后生存时间，提高生存率。

Comparison of the Effect of Thoracoscopy vs Thoracotomy on the Prognosis of Patients with Lymph Node Micrometastasis Detected by Lobectomy

Objective] To explore the effect of thoracoscopy vs thoracotomy on the prognosis of patients with lymph node micrometastasis（N2 ） detected by lobectomy in order to provide the reference for clinical treat-ment .Methods] Totally 60 patients with non-small cell lung cancer disease and lymph node micrometastasis detected by lobectomy were divided into observation group and control group .The observation group（ n=30） underwent thoracoscopy lobectomy ,while the control group（ n=30） underwent thoracotomy lobectomy treat-ment .The blood loss ,operative time ,drainage volume and length of hospital stay were compared between two groups .Survival rate was compared after 3-year follow up .Results] The blood loss ,operation time ,chest drainage volume and time and hospital stay in observation group were lower or less than those in control group ,and there was significant difference（ P 〈0 .05） .There was no significant difference in lymph node re-moval and lymph node metastasis removal between two groups （ P〉0 .05） .Compared with control group ,the incidence of atelectasis in observation group was obviously decreased （ P〉0 .05） .One-year survival rate of ob-servation group was 86 .7% and 3-year survival rate was 56 .7% .The average survival time was （35 .43 ＆#177; 3 .54） months in observation group ,and there was significant difference（ P 〈0 .05） .Conclusion]Compared with thoracotomy ,thoracoscopy lobectomy for the treatment of stage N 2 non-small cell lung cancer has advan-tages such as minimal trauma ,little blood loss ,short operation time ,rapid recovery and few complications , and can effectively prolong survival time and improve the survival rate of patients after operation .