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A standardized technique of systematic mediastinal lymph node dissection by video-assisted thoracoscopic surgery (VATS) leads to a high rate of nodal upstaging in early-stage non-small cell lung cancer.一种通过电视辅助胸腔镜手术(VATS)进行系统性纵隔淋巴结清扫的标准化技术,在早期非小细胞肺癌中导致较高的淋巴结分期上调率。
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本文引用的文献

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[Effects and reasons of conversion during video-assisted thoracic surgery lobectomy].[电视辅助胸腔镜手术肺叶切除术中中转的影响及原因]
Zhonghua Yi Xue Za Zhi. 2014 Dec 23;94(47):3748-50.
2
Single-port video-assisted thoracoscopic surgery for lung cancer.单孔电视辅助胸腔镜手术治疗肺癌
J Thorac Dis. 2014 Jan;6(1):14-21. doi: 10.3978/j.issn.2072-1439.2013.12.43.
3
Totally thoracoscopic major pulmonary resections: an analysis of perioperative complications.完全胸腔镜下肺叶切除术:围手术期并发症分析。
Ann Thorac Surg. 2014 Feb;97(2):419-24. doi: 10.1016/j.athoracsur.2013.09.091. Epub 2013 Nov 20.
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Non-small cell lung cancer, version 2.2013.非小细胞肺癌临床实践指南(2013 年版)
J Natl Compr Canc Netw. 2013 Jun 1;11(6):645-53; quiz 653. doi: 10.6004/jnccn.2013.0084.
5
Video-assisted thoracoscopic lobectomy is associated with better perioperative outcomes than open lobectomy in a veteran population.在老年人群中,与开胸肺叶切除术相比,电视辅助胸腔镜肺叶切除术具有更好的围手术期结局。
Am J Surg. 2012 Nov;204(5):607-12. doi: 10.1016/j.amjsurg.2012.07.022. Epub 2012 Sep 6.
6
Video-assisted thoracic surgery of major pulmonary resections for lung cancer: the Southampton experience.肺癌的电视辅助胸腔镜肺切除术:南安普敦经验。
Eur J Cardiothorac Surg. 2011 Feb;39(2):173-9. doi: 10.1016/j.ejcts.2010.05.029. Epub 2010 Jul 10.
7
Lobectomy by video-assisted thoracic surgery (VATS) versus thoracotomy for lung cancer.电视辅助胸腔镜手术(VATS)与开胸手术治疗肺癌的肺叶切除术对比
J Thorac Cardiovasc Surg. 2009 Jul;138(1):11-8. doi: 10.1016/j.jtcvs.2009.03.030.
8
Cancer statistics, 2009.2009年癌症统计数据。
CA Cancer J Clin. 2009 Jul-Aug;59(4):225-49. doi: 10.3322/caac.20006. Epub 2009 May 27.
9
Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy.早期非小细胞肺癌手术:电视辅助胸腔镜手术与开胸肺叶切除术方法的系统评价
Ann Thorac Surg. 2008 Dec;86(6):2008-16; discussion 2016-8. doi: 10.1016/j.athoracsur.2008.07.009.
10
The approach of fused fissures with fissureless technique decreases the incidence of persistent air leak after lobectomy.采用无裂隙技术融合裂隙可降低肺叶切除术后持续性漏气的发生率。
Eur J Cardiothorac Surg. 2007 Feb;31(2):203-8. doi: 10.1016/j.ejcts.2006.11.030. Epub 2006 Dec 18.

四孔法单操作孔肺叶切除联合纵隔淋巴结清扫术治疗早期非小细胞肺癌的临床价值

[Clinical Value of Four-hole Unilateral Dissecting Lobectomy and Mediastinal Lymph Node Dissection in the Treatment of Early Non-small Cell Lung Cancer].

作者信息

Guo Hong, Diao Yali, Fan Huangxin, Luo Qingquan

机构信息

Department of Thoracic Surgery, Affiliated to Hospital of Yangzhou University, Yangzhou 225000, China.

Department of Thoracic Surgery, Affiliated to Hospital of Shanghai Jiao Tong University, Shanghai 200240, China.

出版信息

Zhongguo Fei Ai Za Zhi. 2018 Aug 20;21(8):578-582. doi: 10.3779/j.issn.1009-3419.2018.08.02.

DOI:10.3779/j.issn.1009-3419.2018.08.02
PMID:30172263
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6105359/
Abstract

BACKGROUND

Thoracoscopic lobectomy combined with mediastinal lymph node dissection has been considered as one of the standard surgical procedures for early lung cancer. After 20 years of development, thoracoscopic lobectomy has reached a consensus on reliability and minimally invasive. At present, thoracoscopic lobectomy has a variety of incisions, which gradually evolve into four holes based on three holes, and two or one hole as the operative approach. The aim of this study was to evaluate the clinical value of four-hole unilateral dissecting lobectomy and mediastinal lymph node dissection in the treatment of non-small cell lung cancer (NSCLC). The aim of this study was to investigate the clinical value of anatomical lobectomy with mediastinal lymphadenectomy under four-hole completely video-assisted thoracoscopic surgery (C-VATS) in the treatment of non-small cell lung cancer.

METHODS

The patients undergoing lobectomy with mediastinal lymphadenectomy for NSCLC were identified in the Department of Thoracic Surgery, Yangzhou First People's Hospital, Yangzhou University from March 2015 to July 2016. Preoperative clinical diagnosis of peripheral-type early NSCLC. The patients were randomly divided into four-hole monophasic group (experimental group) and three-hole group (control group) according to the number of hospitalization before surgery. According to inclusion and exclusion criteria, the 39 cases assign in experimental group and 34 cases in the control group, including 36 males and 37 females; aged 38 to 84 years. The mean operation time, average blood loss, lymph node dissection group, average drainage, average extubation time and postoperative complications were compared between the two groups for statistical analysis.

RESULTS

The two groups of patients were successfully completed surgery, no death after surgery. Mean bleeding in the two groups, the number of lymph node dissection group, the average postoperative drainage, the average time of extubation, postoperative complications, with no significant difference. The average operation time of the four-hole unidirectional group was shorter than that of the three-hole group. The difference was statistically significant (P<0.05).

CONCLUSIONS: The safety and efficacy of a four-hole one-way operation under VATS are satisfactory. The operation is smooth during operation, which shortens the course of operation and deserves the clinical promotion.
.

摘要

背景

电视胸腔镜肺叶切除术联合纵隔淋巴结清扫术被认为是早期肺癌的标准手术方式之一。经过20年的发展,电视胸腔镜肺叶切除术在可靠性和微创性方面已达成共识。目前,电视胸腔镜肺叶切除术有多种切口,逐渐由三孔演变为四孔,并以两孔或单孔作为手术入路。本研究旨在评估四孔单向式肺叶切除术联合纵隔淋巴结清扫术治疗非小细胞肺癌(NSCLC)的临床价值。本研究旨在探讨四孔全胸腔镜手术(C-VATS)下解剖性肺叶切除联合纵隔淋巴结清扫术治疗非小细胞肺癌的临床价值。

方法

选取2015年3月至2016年7月在扬州大学附属扬州市第一人民医院胸外科行肺叶切除联合纵隔淋巴结清扫术治疗NSCLC的患者。术前临床诊断为外周型早期NSCLC。根据术前住院天数将患者随机分为四孔单向组(实验组)和三孔组(对照组)。根据纳入和排除标准,实验组39例,对照组34例,其中男性36例,女性37例;年龄38~84岁。比较两组患者的平均手术时间、平均出血量、淋巴结清扫组数、平均引流量、平均拔管时间及术后并发症,并进行统计学分析。

结果

两组患者均顺利完成手术,术后无死亡。两组患者的平均出血量、淋巴结清扫组数、术后平均引流量、平均拔管时间、术后并发症比较,差异无统计学意义。四孔单向组的平均手术时间短于三孔组。差异有统计学意义(P<0.05)。

结论

VATS下四孔单向手术的安全性和疗效满意。手术过程顺利,缩短了手术时间,值得临床推广。