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  • 刘刚,汪令伟,董林,等.两孔胸腔镜下肺段切除和肺叶切除治疗早期非小细胞肺癌疗效比较[J].同济大学学报(医学版),2020,41(2):235-239.    [点击复制]
  • LIU Gang,WANG Ling-wei,DONG Lin,et al.Comparisons between double-port thoracoscopy-assisted segmental resectionand lobectomy in treatment of early non-small cell lung cancer[J].同济大学学报(医学版),2020,41(2):235-239.   [点击复制]
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两孔胸腔镜下肺段切除和肺叶切除治疗早期非小细胞肺癌疗效比较
刘刚,汪令伟,董林,焦方磊,李钦传
0
(同济大学附属东方医院胸外科,上海200120)
摘要:
目的比较两孔胸腔镜下肺段切除术和肺叶切除术治疗早期非小细胞肺癌(non-small cell lung cancer, NSCLC)的近期疗效和并发症差异。方法选取2017年8月至2018年10月收治的NSCLC患者110例,根据手术方法不同分为两组,胸腔镜下肺段切除组60例,肺叶切除组50例,均为单纯手术治疗患者。对两组患者术后并发症及近期预后情况进行分析。结果肺段切除组手术时间、术中出血量少于肺叶切除组(P<0.05);肺段切除组虽然术后住院时间短于肺叶切除组,但是差异无统计学意义(P>0.05);肺段切除组术后肺漏气的发生率高于肺叶切除组(P<0.05)。肺段切除组术后肺不张、心律失常、发热的发生率虽然低于肺叶切除组,但差异无统计学意义(P>0.05),两组术后乳糜胸、脓胸、支气管胸膜瘘及肺栓塞等严重并发症相比较无差异。术前两组患者的肺功能指标FEV1、MVV无统计学差异(P>0.05);术后肺段切除组肺功能指标均优于肺叶切除组,且组间差异有统计学意义(P<0.05)。两组发生并发症者经对症支持治疗后均获痊愈。结论虽然肺段切除组的术后肺漏气机会更高,但是其术中出血较少、手术时间较短,患者肺功能的保留较优,对患者术后长期日常生活影响较小。肺段切除术在早期NSCLC患者的治疗中值得推广应用。
关键词:  胸腔镜  非小细胞肺癌  肺段切除  肺叶切除
DOI:10.16118/j.1008-0392.2020.02.016
投稿时间:2019-10-28
基金项目:国家自然科学基金面上项目(81773266);上海市浦东新区重点学科群(PWZxq2017-13)
Comparisons between double-port thoracoscopy-assisted segmental resectionand lobectomy in treatment of early non-small cell lung cancer
LIU Gang,WANG Ling-wei,DONG Lin,JIAO Fang-lei,LI Qin-chuan
(Dept. of Thoracic Surgery,East Hospital, Tongji University School of Medicine, Shanghai 200120, China)
Abstract:
ObjectiveTo compare short-term outcome and postoperative complications between simple segmental resection and lobectomy assisted by double-port thoracoscopy in patients with early non-small cell lung cancer(NSCLC). MethodsOne hundred and ten early NSCLC patients treated with double-port thoracoscopy-assisted resection from August 2017 to October 2018 were enrolled in the study, including 60 cases receiving simple segmental resection(segmental resection group) and 50 cases receiving lobectomy(lobectomy group). The postoperative complications and short-term outcome were compared between two groups. ResultsThe operative time and intraoperative blood lost in the segmental resection group were less than those in the lobectomy group(P<0.05). There was a trend of shorter postoperative hospital stay in segmental resection group, but the difference was not statistically significant(P>0.05). The incidence of postoperative pulmonary air leakage in the segmental resection group was significantly higher than that in the lobectomy group(P<0.05). The incidence of atelectasis, arrhythmia and fever in the segmental resection group seemed to be lower than that in the lobectomy group, but the difference was not statistically significant(P>0.05). There was no significant difference in serious complications such as chylothorax, empyema, bronchopleural fistula and pulmonary embolism between the two groups. There was no significant difference in the indexes of pulmonary function between the two groups before operation(P>0.05); while after operation, the indexes of the segmental resection group were better than those of the lobectomy group(P<0.05). The patients with complications in both groups were cured after symptomatic support treatment. ConclusionAlthough the postoperative pulmonary leakage is higher, the intraoperative blood lost is less, the operation time is shorter, the retention of pulmonary function is better, and the effect on the long-term daily life is less in patients undergoing segmental resection, suggesting that compared with lobectomy, segmental resection is worthy of clinical application for early non-small cell lung cancer patients.
Key words:  thoracoscopy  non-small cell lung cancer  segmental resection  lobectomy

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