34例胸腔镜下肺楔形切除与21例肺段切除对位于肺段P区的ⅠA1期非小细胞肺癌治疗比较

目的: 探讨根据影像资料划分病灶所在的肺段位置，来选择位于P区的ⅠA1期非小细胞肺癌的胸腔镜微创手术方法，比较根据新的肺段分区方法采取手术方式的情况及预后。方法: 回顾性分析接受胸腔镜下肺楔形切除术和肺段切除术的患者55例，以手术方式不同分为楔形切除术组(A组，n=34)和肺段切除术组(B组，n=21)。结果: 位于P区的ⅠA1期非小细胞肺癌，A组的手术时间为(18.50±5.55)min，B组为(61.23±9.83)min；术后住院时间两组分别为(3.14±0.95)d和(4.95±1.39)d；术中出血量两组分别为(12.67±6.54)mL和(103.71±16.99)mL；住院经济花费两组分别为(3.59±0.50)万元和(6.19±1.02)万元；术后肺漏气两组分别为2例(5.88%)和6例(28.57%)，上述指标两组间差异均有统计学意义(P < 0.05)。单因素Logistic回归分析显示，手术时间、术后住院时间及肺漏气与不同的手术方式之间有统计学意义的关联(P＜0.05)。多因素二分类Logistic回归分析显示，与B组相比，A组能缩短手术时间(OR=2.58，95%CI：1.71~3.90，P < 0.001)、术后住院时间(OR=2.91，95%CI：1.01~8.84，P=0.04)和减少肺漏气(OR=7.12，95%CI：1.13~37.21，P=0.04)。结论: ⅠA1期非小细胞肺癌患者，病灶位于P区采取的胸腔镜下肺楔形切除术比采取肺段切除术具有明显的优势。

Comparison of 34 cases of thoracoscopic wedge resection and 21 cases of segmental resection for stage ⅠA1 non-small cell lung cancer in area P

Objective: To investigate the selection of minimally invasive thoracoscopic surgery for stage ⅠA1 non-small cell lung cancer (NSCLC) in area P by dividing the lung segment location of the lesion according to the imaging data, and to compare the prognosis of the two methods. Methods: A retrospective analysis was performed on 55 patients who underwent thoracoscopic wedge resection and segmentectomy, and the patients were divided into wedge resection group (group A, n=34) and segmentectomy group (group B, n=21). Results: In groups A and B, the operation time, postoperative hospital stay, intraoperative bleeding, hospitalization costs, and incidence of postoperative pulmonary air leakage were (18.50±5.55) vs. (61.23±9.83), (3.14±0.95) d vs. (4.95±1.39) d, (12.67±6.54) mL vs. (103.71±16.99) mL, (35, 900±5, 000) yuan vs. (61, 900±10, 200) yuan, 5.88% (2 cases) vs. 28.57% (6 cases), respectively, with statistically significant differences (all P < 0.05). Univariate Logistic regression analysis showed a significant correlation between operation time, postoperative hospital stay, incidence of lung leakage and different operation methods (P < 0.05). Multivariate binary Logistic regression analysis showed that compared with group B, group A had shortened operation time (OR=2.58, 95%CI: 1.71-3.90, P < 0.001), shorter postoperative hospital stay (OR=2.91, 95%CI: 1.01-8.84, P=0.04) and reduced incidence of lung leakage (OR=7.12, 95%CI: 1.13-37.21, P=0.04). Conclusion: For patients with stage ⅠA1 NSCLC, thoracoscopic wedge resection of lung with lesion located in area P has a significant advantage over segmental resection.