原发性非小细胞性肺癌胸腔镜微创治疗效果及影响因素分析

目的探讨原发性非小细胞性肺癌(NSCLC)行电视胸腔镜(VATS)微创切除术的临床疗效以及影响疗效的相关因素。方法将2011年1月至2013年1月间收治的90例原发性非小细胞性肺癌患者,采用随机分组对照方法分为观察组(胸腔镜辅助下小切口肺叶切除术)45例,对照组(传统的开胸肺叶切除术)45例。两组间采取KaplanMeier法及Log-rank检验估计各组生存时间的生存率以及中位生存时间,胸腔镜微创治疗效果的影响因素分析采用Cox比例风险回归模型进行多因素分析。结果全组患者中位生存期为27个月。观察组的中位生存期为29个月,1、3、5年生存率分别为77.8%、51.1%以及37.8%;对照组中位生存期为22个月,1、3、5年生存率分别为80.0%、46.7%以及33.3%,两组患者生存率差异无统计学意义(P=0.294);单因素分析显示病灶长度、肿瘤分期、组织分化、支气管切缘情况、清扫的淋巴结数目以及术后是否辅助化疗对NSCLC预后有影响,Cox比例风险回归模型分析显示清扫的淋巴结个数与肿瘤分期是NSCLC的独立影响因素。结论胸腔镜下微创外科治疗NSCLC与传统开胸手术疗效相当;清扫的淋巴结个数和肿瘤分期是预后的独立影响因素。

Video-assisted thoracoscopic surgical treatment efficacy of primary non-small cell lung cancer and Cox regression analysis of influencing factors

Objective To investigate the treatment efficacy and prognosis analysis of primary non-small cell lung cancer（ NSCLC） by video-assisted thoracoscopic surgery（ VATS）. Methods Clinical data of 90 patients with localized NSCLC from Jan. 2011 to Jan. 2013 were reviewed. These patients were randomly divided into the different group. 45 patients receiving video-assisted thoracoscopic surgery lobectomy（ observer group）,and others receiving traditional open thoracotomy（ control group）. The survival rate was analyzed by Kaplan-Meier method and Log-Rank test. Prognostic factors of video-assisted thoracoscopic surgery were analyzed by Cox regression. Results The median survival of 90 patients was 27 months,Median survival of observer group was 29 months,control group was 22 months. The 1,3,5 year survival rates of observer group were 77. 8%,51. 1%,37. 8% respectively. These of control group were 80. 0%,46. 7%,33. 3% respectively. No significant difference in survival rates were found between the groups（ P 〈 0. 05）. Univariate prognostic analysis showed that focal length,cancer stage,histological differentiation,bronchial stump and the number of lymph nodes in lymph nodes dissection were prognostic factors. Multivariate analysis by Cox regression showed that cancer stage and the number of lymph nodes in lymph nodes dissection were the independent prognostic factors for NSCLC.Conclusion The prognosis of VATS and traditional open surgery for NSCLC are no difference. Cancer stage and the number of lymph nodes in lymph nodes dissection are independent factors influencing the prognosis of NSCLC.