胸腔镜肺叶切除术治疗肺良性疾病

目的探讨胸腔镜肺叶切除术在肺良性疾病中的应用价值。方法2002年7月-2007年9月,对35例肺良性疾病行胸腔镜肺叶切除手术。12例施行胸腔镜辅助小切口肺叶切除术,23例施行全胸腔镜肺叶切除术。结果1例因出血中转开胸。全组无围手术期死亡,围手术期并发症3例（8.6%）：术后肺持续漏气2例,肺部感染1例。平均胸管置管时间3.6 d（2-7 d）,术后住院平均7.7 d（2-14 d）。术后病理：支气管扩张15例,炎性假瘤6例,结核5例,真菌感染5例,肺隔离症2例,肺囊肿2例。35例随访5-80个月,平均36.7月,均恢复良好。35例随访5-80个月,平均36.7月,均恢复良好。结论胸腔镜肺叶切除术治疗肺良性疾病在技术上是安全可行的,对于具有手术指征须行肺叶切除的肺良性疾病患者,胸腔镜手术是一种值得推荐的手术方式。     

心包内处理肺血管治疗中晚期肺癌57例手术体会

目的总结心包内处理肺血管全肺切除术或肺叶切除术治疗中晚期肺癌的经验。方法回顾性分析1996年至2006年期间,57例因中晚期肺癌接受心包内处理肺血管全肺切除术或肺叶切除术患者的临床资料。结果全组患者无手术死亡,术后出现心律失常7例,肺水肿3例,肺部感染2例,均治愈。术后获得随访52例,随访率91.2%,随访时间1～5年。术后1,3,5年生存率分别为44.2%、17.3%和11.5%。结论掌握好适应证,心包内处理肺血管全肺切除术或肺叶切除术是一种安全可靠的手术方法,可明显提高中晚期肺癌的肿瘤切除率和手术安全性。     

全电视胸腔镜肺叶切除术治疗肺良性疾病58例临床分析

目的探讨全胸腔镜肺叶切除术（VATsL）治疗肺良性疾病的安全性、可行性和有效性,总结临床经验。方法分析广东省佛山市第一人民医院2008年7月至2011年1月手术治疗58例肺良性疾病患者的临床资料,男36例,女22例;年龄35～65岁,平均年龄50．2岁。胸部CT检查病变部位：右肺上叶7例,有肺中叶16例,有肺下叶12例,左肺上叶8例,左肺下叶15例;均行全胸腔镜肺叶切除术,其中12例为单操作孔。结果全组巾3例心胸腔内粘连重、叶间裂分化差或血管鞘周围淋巴结嵌顿分离肺动脉分支卅血中转开胸,手术时间90～300rain（123．6±93．1rain）,术中出血量50～400ml（223．2±86．9m1）;术后胸腔引流管放置时间2～l7d（7．1±5．2d）,术后住院时间5～16d（9．4±4．9d）。本组患者无嗣手术期死亡;术后m观并发症5例,其中术后肺持续漏气4例,肺部感染1例,均经保守治疗痊愈。术后病理诊断：支气管扩张24例,炎性似瘤9例,结核9例,真菌感染6例,肺隔离症4例,肺囊肿3例,中叶综合征3例。随访5l例,随访6～36个月,均恢复良好。结论全胸腔镜肺叶切除术是治疗肺良性疾病的一种安全有效的方法。     

连续300例全胸腔镜肺叶切除术及中期随访分析

目的总结连续300例行全胸腔镜（VATS）肺叶切除术患者的临床经验,并报道其3年随访结果。方法回顾性分析北京大学人民医院胸外科2006年9月至2009年12月期间完成的连续300例行VATS肺叶切除术患者的临床资料,其中男159例,女141例;年龄18~86岁（58.30±13.90岁）。术前临床诊断：肺占位266例,支气管扩张22例,囊肿/脓肿5例,肺隔离症3例,真菌感染2例,气胸2例。对其手术相关参数及3年随访结果等进行统计分析。结果全组300例患者中良性疾病66例,其中感染性疾病占81.82%（54/66）;恶性疾病234例,其中非小细胞肺癌213例,腺癌占全部恶性疾病的73.08%（171/234）。全组273例完成VATS手术,27例中转开胸,中转开胸率9.00%。完成VATS肺叶切除手术时间3.17±0.88 h,术中出血量225.70±195.20 ml。良性疾病患者的手术时间、术后胸腔引流时间均显著低于恶性疾病（t=2.280,P=0.003;t=1.392,P=0.030）。中转开胸的主要原因为淋巴结与血管致密粘连,占62.96%（17/27）;其它原因主要为术中出血,占18.52%（5/27）。单因素分析结果显示：肺上叶切除术中转开胸风险高于非上叶切除术（χ2=6.131,P=0.013）,而患者性别（χ2=1.182,P=0.277）,良、恶性疾病（χ2=0.210,P=0.647）,病变位于左右侧（2χ=2.933,P=0.087）之间中转开胸风险的差异无统计学意义。全组患者3年随访结果显示：良性疾病患者无症状复发,非小细胞肺癌患者3年总生存率为0.87[95%CI（0.77,0.96）],其中病理分期Ⅰ期患者（135例）3年总生存率为0.91[95%CI（0.85,0.98）]。结论 VATS肺叶切除术是一种安全有效的手术方式,国内VATS肺叶切除术技术及中期效果均达到了国际水平。     

肺癌心包内处理血管的全肺切除手术59例

目的 探讨心包内处理血管的全肺切除术在提高肺癌手术疗效中的作用。方法 对59例肺癌病人行心包内处理血管的全肺切除术,此术式占同期全肺切除术41.8%(59/141例）。结果 手术死亡2例（3.4%),主要并发症13.6%.1、3、5年生存率分别为：86.0%(49/57例）,31.6%(18/57例）和26.3%(15/57例）。3例小细胞肺癌无1例生存逾3年。死亡率和并发症发生率与标准全肺切除术相比差异无显著性,预后与标准全肺切除术亦相近。结论 心包内处理血管的全肺切除是安全的,可提高肺癌切除率,改善生活质量,提高5年生存率。在临床上有应用价值。     

全胸腔镜肺切除术治疗肺曲菌球41例临床分析

目的：探讨全胸腔镜肺切除术治疗肺曲菌球的安全性及可行性。方法回顾分析我院2008年7月-2013年9月全胸腔镜肺切除术治疗肺曲菌球41例的临床资料,均有反复咯血,术前CT提示肺曲菌球可能,病灶直径1-5 cm。肺叶切除术29例,肺段切除术8例,肺楔形切除术4例。结果手术时间：29例肺叶切除（156．4±57．7） min,8例肺段切除（167．5±56．4）min,4例肺楔形切除分别为35、47、54、65 min。出血量20-1100 ml,中位数150 ml。中转开胸3例（胸顶粘连）。术后胸管引流时间2-11 d,中位数3 d;术后住院时间4-19 d,（8±2）d。术后30天无死亡,无严重并发症发生。39例术后随访6-24个月,平均12．5月,5例有少量间断痰血。结论全胸腔镜肺切除术治疗单纯型肺曲菌球是一种安全、可行的手术方法。     

肺结核合并支气管内膜结核的外科治疗

目的 总结肺结核合并支气管内膜结核的外科治疗经验.方法 分析1967年3月到2004年10月间肺结核合并支气管内膜结核患者85例,其中支气管狭窄45例,气管狭窄4例.43例行肺叶切除术,其中袖式切除8例;37例行全肺切除术,其中袖式切除4例,气管右下壁部分切除后使用右主支气管内壁组织修补术3例;3例行气管节段切除成形术;1例行左上叶支气管、肺动脉双袖式切除术;1例行开胸活检术.结果 无手术死亡病例.肺叶切除术35例(不包括袖式肺叶切除术)中,术后并发支气管胸膜瘘1例、脓胸1例;全肺切除术33例(不包括袖式全肺切除术)中,术后并发支气管胸膜瘘3例、脓胸4例;两种术式间差异有统计学意义.肺叶切除术后肺不张发生率(5/35)低于袖式肺叶切除术(3/8)(P＜0.01).随访3～10年,随访率98%;1例患者术后7年后死于急性呼吸功能衰竭.结论 肺结核合并支气管内膜结核的外科治疗应切除病变组织,根据狭窄的部位、长度、程度及狭窄远端的肺组织是否正常决定手术方式,并结合围手术期正规抗结核治疗,尽量少作全肺切除.     

胸腔镜肺叶切除术与肺段切除术治疗T1b N0M0期非小细胞肺癌的回顾性队列研究

目的 探讨胸腔镜肺叶切除术与肺段切除术治疗T1b N0M0期非小细胞肺癌的临床效果。方法 回顾性分析2012—2015年江阴市人民医院收治的181例T1bN0M0期非小细胞肺癌患者的临床资料。根据手术方法将患者分为肺叶切除组和肺段切除组：肺叶切除组117例,其中男46例、女71例,年龄（61.32±8.94）岁;肺段切除组64例,其中男20例、女44例,年龄（58.55±12.57）岁。观察并比较两组患者围手术期相关指标及预后情况。结果 肺段切除组较肺叶切除组手术时间更长、术中出血量更少、术后住院时间更短、肺功能保留更多（P<0.05）。而肺叶切除组与肺段切除组相比,肺结节实性成分占比更高、肿瘤直径更大、淋巴结清扫数量更多（P<0.05）。两组患者5年总生存、无复发生存差异无统计学意义（P>0.05）。结论 对于T1bN0M0期非小细胞肺癌患者,胸腔镜肺段切除与肺叶切除具有相似的预后,但肺段切除术损伤更小、患者康复更快,与肺叶切除术相比更有优势。     

局部肺循环临时阻断在复杂肺切除术中的应用

目的探讨局部肺循环临时阻断在复杂肺切除术中的应用价值和技术细节。方法接受局部肺循环临时阻断条件下的肺切除手术24例,12例接受支气管、肺动脉、静脉联合成形术,其中4例为支气管肺动脉“双袖”成形术;10例肺动脉成形或同时联合肺静脉成形（其中1例联合左心房成形术）;2例单纯肺动脉、静脉阻断切除肺叶或全肺。在“双袖”成形术中采用左房血反流氧合残肺。结果术后30 d内死亡2例,死亡原因分别为右全肺切除术后呼吸衰竭和肺动脉成形术后急性肺动脉栓塞。4例接受“双袖”成形术的患者术后均产生不同程度的残肺水肿,术后14-18 d完全恢复。发生脓胸1例（4.2%）,肺炎6例（25.0%）,漏气3例（12.5%）。Ⅰ-Ⅱ期肺癌患者中位生存期为36个月,ⅢA期患者中位生存期为18个月。结论局部肺循环临时阻断在复杂肺切除术中的应用能降低术中风险,简化操作程序,达到最大限度保留健康肺组织和最大限度切除癌肿的目的,有临床实用价值。     

肺切除术联合化疗治疗耐多药肺结核51例

目的探讨肺切除联合化疗治疗耐多药肺结核的临床应用价值,总结治疗经验。方法 1999年1月至2007年1月,我科共收治51例主病灶局限于肺叶或单侧全肺的耐多药肺结核患者,男38例,女13例;年龄18～56岁,平均年龄36.5岁。施行肺叶切除术30例,肺叶加同侧肺段切除术或同侧双肺叶切除术11例,全肺切除术10例;分析术后继续抗结核化疗18～24个月的疗效。结果 51例患者均手术成功,46例完成化疗(18～24个月)后治愈;治疗失败5例,其中3例在疗程最后6个月痰菌仍为阳性,2例于围手术期内死于术后并发症。术后发生并发症12例,其中术后1个月内发生9例:呼吸功能衰竭3例,均经呼吸机辅助呼吸治愈;脓胸3例,2例经胸腔闭式引流治愈,1例术后3周死于多器官功能衰竭;支气管胸膜瘘1例,经留置胸腔引流管3个月后瘘口逐渐闭合治愈;暂时性视力障碍1例,未作特殊处理,1个月后视力恢复正常,急性肺水肿1例,治疗无效死亡。1个月后发生并发症3例:切口感染2例,经开放引流每日换药,行二期缝合伤口Ⅲ/丙愈合;支气管胸膜瘘1例,行胸部肌瓣填塞+胸廓成形术后支气管胸膜瘘再度复发,给予胸壁开放式引流,长期未愈,72个月后因大咯血窒息死亡。结论对主病灶局限的耐多药肺结核患者施行肺切除联合抗结核化疗,治愈率高,并发症发生率及病死率均在可接受范围内。     

Multiple primary lung cancers. Results of surgical treatment

During a 13-year period, multiple primary lung cancers were diagnosed in 80 consecutive patients. Forty-four patients had metachronous cancers. The initial pulmonary resection was lobectomy in 36 patients, bilobectomy in 3, pneumonectomy in 1, and wedge excision or segmentectomy in 4. The second pulmonary resection was lobectomy in 16 patients, bilobectomy in 2, completion pneumonectomy in 7, and wedge excision or segmentectomy in 19. There were two 30-day operative deaths (mortality rate, 4.5%). Actuarial 5- and 10-year survival rates after the first pulmonary resection for stage I disease were 55.2% and 27.0%, respectively. Five-year and 10-year survival rates for stage I disease after the second pulmonary resection were 41.0% and 31.5%, respectively. The remaining 36 patients had synchronous cancers. The pulmonary resection was lobectomy in 18 patients, bilobectomy in 3, pneumonectomy in 10, and wedge excision or segmentectomy in 8. There were two 30-day operative deaths (mortality rate, 5.6%). Actuarial overall 5- and 10-year survival rates after pulmonary resection were 15.7% and 13.8%, respectively. We conclude that an aggressive surgical approach is safe and warranted in most patients with multiple primary lung cancers and that the presence of synchronous primary cancers is ominous.     

Mortality, complications and loss of pulmonary function after pneumonectomy vs. sleeve lobectomy in patients younger and older than 70 years

Retrospective single institution analysis of all patients undergoing sleeve lobectomy or pneumonectomy between 2000 and 2005. Seventy-eight patients underwent pneumonectomy (65 patients <70 years, 13 patients >70 years) and 69 sleeve lobectomy (50 patients <70 years, 19 patients >70 years). Pre-existing co-morbidity, surgical indication and induction therapy was similarly distributed between treatment by age-groups. In patients <70 years, pneumonectomy and sleeve lobectomy resulted in a 30-day mortality of 3% vs. 0 and an overall complication rate of 26% vs. 44%, respectively. In patients >70 years, pneumonectomy and sleeve lobectomy resulted in a 30-day mortality of 15% vs. 0 and an overall complication rate of 23% vs. 32%. In both age groups, pneumonectomy was associated with more airway complications (NS) and a significantly higher postoperative loss of FEV(1) than sleeve lobectomy (P<0.0001, P<0.03). Age per se did not influence the loss of FEV(1) and DLCO for a given type of resection. Sleeve lobectomy may have a therapeutic advantage over pneumonectomy in the postoperative course of elderly patients.     

Iterative surgical resections for local recurrent and second primary bronchogenic carcinoma.

OBJECTIVE: To report our experience with repeated pulmonary resection in patients with local recurrent and second primary bronchogenic carcinoma, to assess operative mortality and late outcome. METHODS: The medical records of all patients who underwent a second lung resection for local recurrent and second primary bronchogenic carcinoma from 1978 through 1998 were reviewed. RESULTS: There were 27 patients. They constituted 2.5% of 1059 patients who had undergone lung resection for bronchogenic carcinoma in the same period. Twelve patients (1.1%) (group 1) had a local recurrence that developed at a median interval of 24 months (range 4-83).The first pulmonary resection was lobectomy in ten patients and segmentectomy in two. The second operation consisted of completion pneumonectomy in ten cases, completion lobectomy in one and wedge resection of the right lower lobe after a right upper lobectomy in one. The other 15 patients (1.4%) (group 2) had a new primary lung cancer that developed at a median interval of 45 months (range 21-188).The first pulmonary resection was lobectomy in 12 patients, bilobectomy in one and pneumonectomy in two. The second pulmonary resection was controlateral lobectomy in seven patients, controlateral sleeve lobectomy in two, controlateral pneumonectomy in 1, controlateral wedge resection in four and completion pneumonectomy in one. Overall hospital mortality was 7.4%, including one intraoperative and one postoperative death in group 1 and 2, respectively. Five-year survival after the second operation was 15.5 and 43% with a median survival of 26 and 49 months in groups 1 and 2, respectively (P=ns). CONCLUSIONS: Long-term results justify complete work-up of patients with local recurrent and second primary bronchogenic carcinoma. Treatment should be surgical, if there is no evidence of distant metastasis and the patients are in good health. Early detection of second lesions is possible with an aggressive follow-up conducted maximally at 4 months intervals for the first 2 years and 6 months intervals thereafter throughout life.     

Video-assisted thoracic surgery for metachronous lung cancer

Of 1,391 patients who underwent operation for primary lung cancer between 2000 and 2009, 50 patients (3.6%) had a past history of pulmonary resection for lung cancer. Three patients underwent completion pneumonectomy by thoracotomy and in the other 47 patients video-assisted thoracic surgery (VATS) was performed. We considered 42 cases (3 of completion pneumonectomy and 39 of VATS) to be metachronous lung cancer and 8 cases of VATS to be recurrence by detailed histologic assessment. We examined 39 cases of metachronous lung cancer resected by VATS. The patients were aged 68 +/- 8 years and 4 patients were aged 80-years or more. The surgical procedures performed were lobectomy in 4 patients, segmentectomy in 3, and wedge resection in 40. The operation time was 121 +/- 66 minutes and the blood loss was 67 +/- 140 ml. There were no major complications. We registered 6 deaths during follow-up; 3 were due to disease progression and 3 were due to other causes. The survival rate of the 42 patients including 3 patients who underwent completion pneumonectomy was 74.9% at 5 years. Early detection of metachronous lung cancer and surgical resection offers a favorable prognosis.     

Surgical Treatment of Lung Cancer Invading the Left Atrium or Base of the Pulmonary Vein

Background  The purpose of the present study was to explore the efficacy of an extended operation for locally advanced non-small cell lung cancer invading the left atrium and intrapericardial pulmonary vein. Methods  From January 2000 to January 2006, lobectomy or pneumonectomy combined with extended resection of the left atrium was carried out in 46 patients. The operations included left lower lobectomy in 6 cases, left pneumonectomy in 14 cases, right middle and lower lobectomy in 8 cases, right lower lobectomy in 2 cases, and right pneumonectomy in 16 cases; these cases accounted for 4.9% of the lung cancer patients who underwent surgical treatment in the Changzheng Hospital, Second Military Medical University, during the study period. Results  There were no surgery-related deaths, and the overall 1-, 3-, and 5-year survival rates were 71.77%, 37.79%, and 22.04%, respectively; the 1-, 3-, and 5-year survival rates of patients with no lymph node involvement (N0) were 77.16%, 43.40%, and 28.94%, respectively; the 1-, 3-, and 5-year survival rates of N1 patients were 75.94%, 41.88%, and 27.92%, respectively; the 1- and 3-year survival rates of N2 patients were 53.85% and 17.95%, respectively. Conclusions  Surgical treatment of T4 lung cancer invading the left atrium or the base of the pulmonary vein is feasible, particularly in N0 and N1 patients with a ≤3 cm maximum diameter of primary lung cancer. It can improve the quality of life and increase long-term survival. Surgical management should be considered in selected lung cancer patients.     

Results of surgical treatment for pulmonary aspergilloma.

OBJECTIVES: The purpose of this retrospective study is to analyze the results of the surgical treatment for pulmonary aspergilloma and to confirm that aggressive surgical resection can provide effective outcome for these patients. PATIENTS AND METHOD: From 1987 to 2000, 110 patients underwent thoracotomy for treatment of pulmonary aspergilloma in two hospitals. The most common indication for operation was hemoptysis (82%). Underlying diseases were tuberculosis (89%), bronchiectasis (5%), carcinoma (3%), lung tumor (1%) and none (2%). The procedures were lobectomy (74%), segmentectomy (12%), wedge resection (9%), pneumonectomy (4%) and cavernoplasty in two patients. Twenty-nine patients (26%) had severe underlying intrathoracic pathologies. RESULTS: Postoperative complications occurred in 23.6% of the patients including: empyema (n=13), bleeding (n=6), respiratory insufficiency (n=2), wound infection (n=4) and bronchopleural fistula (n=1). There was one hospital death due to panperitonitis after gastric ulcer perforation. CONCLUSIONS: We recommend early surgical resection of symptomatic aspergilloma and even asymptomatic cases with reasonable complication.     

Surgery for intrathoracic recurrence of non-small cell lung cancer

In this study, we defined a solitary lung nodle in the same histology which could be traced its' origin from carcinoma in situ or was found over than two years' follow up as a second primary lung cancer. These cases were excluded. Eighteen cases underwent second surgery for intrathoracic recurrence. Fourteen cases were male and four cases were female. Their ages ranged from 23 to 75 (average 59.6) years. The histology were adenocarcinoma in 9 cases, squamouscarcinoma in 7, adenosquamous carcinoma in 1, large cell carcinoma in 1. The initial surgical procedures were lobectomy in 17, partial resection in 1. The initial stage were I in 13, II in 2, IIIA in 1. Pulmonary recurrence were found in 10, bronchial stump recurrence were found in 4, pulmonary hilus lymph node recurrence were found in 2, mediastinal lymph node recurrence were found in 2, pulmonary stump recurrence was found in 1. The second surgical procedures were completion pneumonectomy in 7, completion lobectomy in 1, lobectomy with segmentectomy in 1, segmentectomy or partial resection in 7, mediastinal dissection in 2. The overall 5-year survival rate of the patients with recurrence after reoperation was 31.8%. An aggressive surgical approach for recurrent lung cancer should be recommended.     

Surgical treatment of pulmonary metastases from colon and rectal cancer

We retrospectively studied the surgical treatment for pulmonary metastases from colon and rectal cancer. A total of 24 patients (9 males and 15 females; mean age 61 years) underwent 29 thoracotomies for metastatic colon carcinoma, while 22 patients (16 males and 6 females; mean age 63 years) underwent 29 thoracotomies for metastatic rectal cancer. The median interval between the primary procedure and lung resection for metastases was 26 months in the patients with colon carcinoma and 32 months in the patients with rectal cancer. In the patients with colon carcinoma, 16 underwent wedge resection or segmentectomy (including 4 video-assisted procedures) and 13 (54%) underwent lobectomy or pneumonectomy. In the patients with rectal cancer, 15 underwent wedge or segmentectomy (including 1 video-assisted procedure), 13 (59%) underwent lobectomy or pneumonectomy, and 1 underwent exploratory thoracotomy. All procedures except exploratory thoracotomy were curative operations. There was no mortality. Overall 5-year survival was 56% (n=46). Five-year survival was 65% for patients with colon metastases (n=24) and 45% for patients with rectal metastases (n=22), and there was no significant difference. Recurrent sites were 4 lungs (36%), 4 livers (36%), 1 bone, 1 uterus, and 1 peritoneum in patients with colon carcimoma, and 10 lungs (43%), 5 brains (22%), 3 livers (13%), 1 bone, and 1 vagina in patients with rectal cancer. Pulmonary resection for metastases from colon carcinoma may have better prognosis than that from rectal cancer. However, further investigation may be required to obtain convincing conclusions.     

Limited and radical resection for tracheal and bronchopulmonary carcinoid tumour. Report on 227 cases

Bronchopulmonary carcinoid tumours occur at all levels from the trachea to the lung periphery. Over a 20-year period. 227 patients with carcinoid tumour underwent thoracotomy. The age at operation ranged from 14 to 79 years. Haemoptysis, chronic cough, recurrent infection and wheeze were the most common symptoms; 24% of patients were asymptomatic. The primary tumour was within the trachea or the main, lobar or segmental bronchi in 190 patients (83.7%). A variety of surgical procedures were employed: pneumonectomy in 32 patients; lobectomy and bilobectomy including bronchial sleeve resection in 144; segmentectomy in 18; wedge excision in 19; bronchial sleeve only in 5; carinal resection in 2; tracheal resection in 4 and bronchotomy in 3 cases. There was only 1 hospital death in the 227 patients (mortality: 0.44%). Survival at 5 and 10 years in patients with benign carcinoid was 97.5% and 95%, respectively. In patients with the atypical form it was 41.2%. The peripheral carcinoid was usually totally removed by an ample wedge excision or segmental resection and the central bronchial carcinoid by sleeve resection with lobectomy rather than pneumonectomy. The atypical variant, because of the frequency of lymphatic involvement, should be treated as a bronchial carcinoma by radical resection.     

T1期非小细胞肺癌肺叶切除和亚肺叶切除的临床疗效比较

目的探讨肺叶切除和亚肺叶切除在T1期非小细胞肺癌(NSCLC)(肿瘤直径≤3 cm)外科治疗中的应用价值。 方法收集2007年1月至2014年12月在北京中日友好医院胸外科接受手术治疗的278例T1期NSCLC患者的临床资料。患者平均年龄(60.7 ± 10.4)岁。其中亚肺叶切除61例(楔形切除35例,肺段切除26例),肺叶切除217例。腺癌占81.7%,鳞癌占12.9%,其他占5.4%;高分化癌占8.6%,中分化癌占27.0%,低分化癌占20.5%,不能确定占43.9%。在腺癌中,浸润前病变占4.0%,微浸润腺癌占7.5%,浸润性腺癌占88.5%。T1N0M0占86.7%,T1N1M0占1.1%,T1N2M0占12.2%。 结果与肺叶切除组比较,亚肺叶切除组患者年龄较大、手术时间较短、病变≤2 cm的比例较高,两组间比较差异均有统计学意义(t＝0.496,P＝0.009;t＝8.082,P＝0.029;χ²＝2.105,P＝0.002)。但两组间在1秒钟用力呼气容积(FEV₁)、FEV₁%,以及手术方式和术后并发症发生率方面,差异均无统计学意义(t＝0.065,P＝0.713;t＝2.12,P＝0.085;χ²＝0.399,P＝0.274;χ²＝0.438,P＝0.490)。对于T1N0M0的NSCLC患者,亚肺叶和肺叶切除组患者的5年生存率分别为73.9%和83.5%,差异无统计学意义(P＝0.883)。亚肺叶切除组内分析显示：楔形切除组和肺段切除组患者的5年生存率分别为79.4%和70.6%,差异无统计学意义(P＝0.979)。多因素分析显示：仅有年龄和纵隔淋巴结转移N2为预后不良的危险因素(HR＝1.07,P＝0.048;HR＝5.56,P＝0.011)。亚肺叶切除组患者的5年生存率与肺叶切除组比较差异无统计学意义(HR＝1.38,P＝0.552)。 结论对于T1N0M0的NSCLC患者,亚肺叶切除虽然不可能完全替代肺叶切除手术,但是对于肺功能储备较差的老年患者可能逐渐成为主流术式。