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一种新型功能性淋巴结清扫方法在电视辅助胸腔镜手术右肺非小细胞肺癌根治性切除术中的临床价值

The clinical value of a new method of functional lymph node dissection in video-assisted thoracic surgery right non-small cell lung cancer radical resection.

作者信息

Chen Sui, Huang Shijie, Yu Shaobin, Han Ziyang, Gao Lei, Shen Zhimin, Kang Mingqiang

机构信息

Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.

Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350122, China.

出版信息

J Thorac Dis. 2019 Feb;11(2):477-487. doi: 10.21037/jtd.2019.01.15.

Abstract

BACKGROUND

To evaluate the safety, thoroughness and feasibility of "tunnel-type mediastinal lymph node dissection" in video-assisted thoracic surgery (VATS) for right non-small cell lung cancer (NSCLC) radical resection, which functionally dissected the lymph nodes of station 2R/4R/7.

METHODS

A retrospective study was performed in the clinical data of 196 patients with VATS right NSCLC radical resection. According to the different methods of lymph node dissection of station 2R, 4R and 7, they were divided into the tunnel-type group (n=102) and the routine group (n=94). The clinical data of two group were compared.

RESULTS

The analyses of the baselines of the two groups are comparable. For lymph nodes dissection of station 2R/4R/7, operation time, the total number, positive number and metastasis incidence shown no significant difference between two groups (P>0.05). However, the amount of bleeding, postoperative thoracic drainage volume, extubation time, hospitalization days, the incidence of postoperative pulmonary infection and chronic cough were significantly lower in the tunnel-type group (P<0.05). There was no significant difference in 3-year recurrence and metastasis and in 3-year survival between tunnel-type group and routine group.

CONCLUSIONS

The tunnel-type group has more advantages, such as less surgical trauma, shorter hospitalization time, faster postoperative rehabilitation, even less postoperative chronic cough compared with the routine group. Therefore, we believe that the tunnel-type mediastinal lymph node dissection is a safe, thorough and feasible surgical method, which is worthy of being popularized and applied in the VATS right NSCLC radical resection.

摘要

背景

为评估电视辅助胸腔镜手术(VATS)行右非小细胞肺癌(NSCLC)根治性切除时“隧道式纵隔淋巴结清扫术”的安全性、彻底性及可行性,该术式对2R/4R/7组淋巴结进行功能性清扫。

方法

对196例行VATS右NSCLC根治性切除患者的临床资料进行回顾性研究。根据2R、4R和7组淋巴结清扫方式不同,分为隧道式组(n = 102)和常规组(n = 94)。比较两组临床资料。

结果

两组基线分析具有可比性。对于2R/4R/7组淋巴结清扫,两组手术时间、淋巴结总数、阳性数及转移发生率差异无统计学意义(P > 0.05)。然而,隧道式组术中出血量、术后胸腔引流量、拔管时间、住院天数、术后肺部感染及慢性咳嗽发生率显著低于常规组(P < 0.05)。隧道式组与常规组3年复发转移率及3年生存率差异无统计学意义。

结论

与常规组相比,隧道式组具有手术创伤小、住院时间短、术后康复快、术后慢性咳嗽更少等优势。因此,我们认为隧道式纵隔淋巴结清扫术是一种安全、彻底、可行的手术方法,值得在VATS右NSCLC根治性切除中推广应用。

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