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胸腔镜肺段切除术治疗非小细胞肺癌的可行性与有效性

Feasibility and effectiveness of thoracoscopic pulmonary segmentectomy for non-small cell lung cancer.

作者信息

Ma Mingsheng, He Fan, Lv Xiangyang, Wang Xiaoyan, Dong Sizeng, Liu Chao, Zhou Cuiping

机构信息

Department of Cardiac Surgery.

Department of Cardiothoracic Surgery, Department of Obstetrics, The Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China.

出版信息

Medicine (Baltimore). 2020 Jan;99(5):e18959. doi: 10.1097/MD.0000000000018959.

Abstract

The outcomes of minimally invasive thoracoscopic pulmonary segmentectomy for non-small cell lung cancer (NSCLC) still need to be defined. This study aimed to investigate the feasibility and effectiveness of thoracoscopic pulmonary segmentectomy in patients with early peripheral NSCLC.This was a retrospective study of patients with early peripheral NSCLC admitted between January 2013 and January 2017. Patients were divided into the segmentectomy and lobectomy groups (40/group), according to the surgery they underwent. Blood loss, operation time, removal of drainage tube time, inflammatory response after operation, postoperative complications, postoperative lung function, local recurrence, and survival were compared.Blood loss and removal of drainage tube time were not significantly different between the 2 groups (all P > .05). Operation time in the segmentectomy group was longer than in the lobectomy group (P < .001). The postoperative interleukin-6, procalcitonin, and C-reactive protein changes in the segmentectomy group were significantly lower than in the lobectomy group (all P < .001). The pulmonary function at 2 weeks was significantly reduced in the 2 groups (all P < .001), but it was better in the segmentectomy group than in the lobectomy group (all P < .05). The 1- and 3-year local recurrence disease-free, and overall survival rates were not significantly different between the 2 groups (P > .05). The multivariable analysis could not identify any factor associated with local recurrence or survival (all P > .05).Thoracoscopic pulmonary segmentectomy and lobectomy are both acceptable for the treatment of early peripheral NSCLC, but segmentectomy was associated with lower postoperative inflammation and better postoperative pulmonary function than lobectomy.

摘要

非小细胞肺癌(NSCLC)的微创胸腔镜肺段切除术的疗效仍有待明确。本研究旨在探讨胸腔镜肺段切除术治疗早期周围型NSCLC患者的可行性和有效性。

这是一项对2013年1月至2017年1月收治的早期周围型NSCLC患者的回顾性研究。根据患者接受的手术方式,将其分为肺段切除术组和肺叶切除术组(每组40例)。比较两组患者的失血量、手术时间、引流管拔除时间、术后炎症反应、术后并发症、术后肺功能、局部复发情况及生存率。

两组患者的失血量和引流管拔除时间差异无统计学意义(均P>0.05)。肺段切除术组的手术时间长于肺叶切除术组(P<0.001)。肺段切除术组术后白细胞介素-6、降钙素原和C反应蛋白的变化显著低于肺叶切除术组(均P<0.001)。两组术后2周时肺功能均显著下降(均P<0.001),但肺段切除术组优于肺叶切除术组(均P<0.05)。两组患者1年和3年的局部复发无病生存率及总生存率差异无统计学意义(P>0.05)。多变量分析未发现与局部复发或生存相关的因素(均P>0.05)。

胸腔镜肺段切除术和肺叶切除术均可用于治疗早期周围型NSCLC,但与肺叶切除术相比,肺段切除术术后炎症反应更低,肺功能更好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adf3/7004666/7238d5764dac/medi-99-e18959-g003.jpg

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