胸腔镜下肺叶与肺段切除术治疗早期非小细胞肺癌的临床效果观察

张炳太; 张雷; 刘军; 李洪林; 刘学刚

doi:10.16766/j.cnki.issn.1674-4152.002362

胸腔镜下肺叶与肺段切除术治疗早期非小细胞肺癌的临床效果观察

doi: 10.16766/j.cnki.issn.1674-4152.002362

1.
蚌埠医学院第一附属医院胸心外科，安徽蚌埠 233004
2.
蚌埠市第三人民医院胸心外科，安徽蚌埠 233000

基金项目:

安徽省教育厅重点课题 KJ2019A0340

详细信息

通讯作者:
刘学刚，E-mail：XgLiu99@126.com

中图分类号: R734.2 R730.56
计量
- 文章访问数: 304
- HTML全文浏览量: 198
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-07
- 网络出版日期: 2022-08-13

Clinical effect observation of thoracoscopic lobectomy and segmentectomy in the treatment of early non-small cell lung cancer

1.
Department of Thoracic and Cardiac Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的观察胸腔镜下肺叶与肺段切除术治疗早期非小细胞肺癌(NSCLC)患者的临床疗效，并分析2组差异。方法选取2018年1月—2019年12月于蚌埠医学院第一附属医院胸心外科就诊的早期NSCLC患者60例，根据手术方式分为2组，观察组采用胸腔镜下肺段切除术(30例)，对照组采用胸腔镜下肺叶切除术(30例)。对比2组围手术期相关指标及术后并发症发生情况，分析2组术前、术后肺功能和生存质量差异。结果观察组与对照组相比，手术时间长[(140.32±12.31)min vs. (109.82±14.52)min]，术后引流时间和住院时间短[(5.12±1.07)d vs. (5.89±0.95)d, (7.89±1.24)d vs. (9.18±1.32)d]，术中出血量少[(65.09±15.45)mL vs. (86.46±17.87)mL，均P＜0.05]。观察组术后肺漏气发生率较高，术后2组并发症总发生率差异无统计学意义(P>0.05)。2组术前肺功能指标(FEV₁、FVC)差异无统计学意义(均P>0.05)；术后2组组间及组内不同时点间肺功能指标差异有统计学意义(均P＜0.05)；组别与时间存在交互作用(F_交互=65.982、61.374，均P＜0.05)。2组术前KPS评分差异无统计学意义(P>0.05)；术后2组组间及组内不同时点间KPS评分差异有统计学意义(均P＜0.05)；组别与时间存在交互作用(F_交互=50.233，P＜0.05)。结论胸腔镜肺段切除术治疗早期NSCLC患者总体效果优于肺叶切除术，术中出血少，术后恢复快，对肺功能影响小，具有重要的临床应用价值。
- 完全胸腔镜 /
- 肺叶切除术 /
- 肺段切除术 /
- 早期非小细胞肺癌
Abstract: Objective To observe the clinical efficacy of thoracoscopic lobectomy and segmental lung resection in the treatment of patients with early stage non-small cell lung cancer (NSCLC), and analyse the differences between the two groups. Methods Sixty patients with early NSCLC who were admitted to the Department of Cardiac Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to December 2019 were selected. According to surgical methods, they were divided into the observation group (thoracoscopic segmentectomy) (n=30) and control group (thoracoscopic lobectomy) (n=30). Perioperative related indicators and postoperative complications were compared between the two groups, and preoperative and postoperative lung function and quality of life were analysed. Results Compared with the control group, the observation group had longer operation time[(140.32±12.31) min vs. (109.82±14.52) min], shorter postoperative drainage time and hospitalisation time[(5.12±1.07) days vs. (5.89±0.95) days, (7.89±1.24) days vs. (9.18±1.32) days], and lesser intraoperative blood loss[(65.09±15.45) mL vs. (86.46±17.87) mL, all P < 0.05]. The incidence of pulmonary air leakage was higher in the observation group, and no statistical significance was observed in the incidence of postoperative complications between the two groups (P>0.05). No significant difference was observed in preoperative lung function indexes (FEV₁, FVC) between the two groups (all P>0.05). Statistically significant differences were observed in lung function indexes between the two groups and within the two groups at different time points after operation (all P < 0.05). An interaction was observed between group and time (F_interaction=65.982, 61.374, all P < 0.05). No significant difference was observed in preoperative KPS scores between the two groups (P>0.05). Statistically significant differences were observed in the KPS scores between the two groups and at different time points within the group after surgery (all P < 0.05). An interaction was observed between group and time (F_interaction=50.233, P < 0.05). Conclusion The overall effect of thoracoscopic pulmonary segmentectomy in the treatment of patients with early NSCLC is better than that of lobectomy, with lesser intraoperative bleeding, faster postoperative recovery and little impact on lung function, which has important clinical application value.
- Complete thoracoscopy /
- Lobectomy /
- Pulmonary segmentectomy /
- Early non-small cell lung cancer

HTML全文

表 1 2组早期NSCLC患者一般资料比较

Table 1. Comparison of general data of early NSCLC patients between the two groups

组别	例数	性别 (男/女, 例)	年龄 (x±s, 岁)	体重指数 (x±s)	肿瘤直径 (x±s, cm)	TNM分期(例)		病理类型(例)
组别	例数	性别 (男/女, 例)	年龄 (x±s, 岁)	体重指数 (x±s)	肿瘤直径 (x±s, cm)	Ⅰa1期	Ⅰa2期	腺癌	鳞癌	腺鳞癌	大细胞癌	神经内分泌癌
对照组	30	17/13	56.75±7.38	22.73±1.89	1.70±0.23	23	7	19	7	2	1	1
观察组	30	18/12	57.38±7.96	22.80±1.92	1.68±0.20	24	6	20	7	1	2	0
统计量		0.069^a	0.422^b	0.142^b	0.359^b	0.098^a		0.127^a
P值		0.793	0.752	0.887	0.721	0.754		0.703
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组早期NSCLC患者围手术期相关指标比较(x±s)

Table 2. Comparison of perioperative indicators of early NSCLCpatients between the two groups (x±s)

组别	例数	手术时间(min)	术中出血量(mL)	术后引流时间(d)	术中淋巴结清扫数目(个)	住院时间(d)
对照组	30	109.82±14.52	86.46±17.87	5.89±0.95	12.28±2.12	9.18±1.32
观察组	30	140.32±12.31	65.09±15.45	5.12±1.07	12.53±2.79	7.89±1.24
t值		8.776	4.955	2.948	0.391	3.901
P值		＜0.001	＜0.001	0.005	0.697	＜0.001

下载: 导出CSV

表 3 2组早期NSCLC患者术后并发症发生情况比较

Table 3. Comparison of postoperative complications betweenthe two groups of patients with early NSCLC

组别	例数	肺漏气 (例)	肺部感染(例)	肺不张 (例)	心房颤动 (例)	呼吸衰竭 (例)	总发生率 (%)
对照组	30	1	3	5	3	1	43.33(13/30)
观察组	30	6	1	1	1	0	30.00(9/30)
注：2组并发症总发生率比较，χ²=1.148，P=0.284。

下载: 导出CSV

表 4 2组早期NSCLC患者不同时间点肺功能指标比较(x±s, L)

Table 4. Comparison of lung function indexes at different time points between the two groups of patients with early NSCLC (x±s, L)

组别	例数	FEV₁			FVC
组别	例数	术前	术后3个月	术后1年	术前	术后3个月	术后1年
对照组	30	2.03±0.12	1.28±0.13^a	1.54±0.17^ab	2.17±0.19	1.35±0.13^a	1.65±0.15^ab
观察组	30	2.02±0.10	1.52±0.15^a	1.73±0.16^ab	2.18±0.23	1.58±0.17^a	1.78±0.12^ab
t值		0.351	6.623	10.558	0.184	5.887	3.707
P值		0.727	＜0.001	＜0.001	0.855	＜0.001	＜0.001
注：与术前比较，^aP＜0.05；与术后3个月比较，^bP＜0.05。

下载: 导出CSV

表 5 2组早期NSCLC患者不同时间点KPS评分比较(x±s, 分)

Table 5. Comparison of KPS scores between the two groupsof patients with early NSCLC at differenttime points (x±s, points)

组别	例数	术前	术后3个月	术后1年
对照组	30	77.41±3.56	80.63±2.34^a	84.65±3.08^ab
观察组	30	76.83±3.42	85.42±2.98^a	89.63±2.45^ab
t值		0.644	6.924	6.931
P值		0.522	＜0.001	＜0.001
注：与术前比较，^aP＜0.05；与术后3个月比较，^bP＜0.05。

下载: 导出CSV

参考文献(21)

[1]	戚胜波, 刘永靖, 陶宇, 等. 胸腔镜肺叶切除术与肺段切除术治疗早期肺癌的临床分析[J]. 临床肺科杂志, 2020, 25(5): 740-744. doi: 10.3969/j.issn.1009-6663.2020.05.020 QI S B, LIU Y J, TAO Y, et al. Clinical analysis of thoracoscopic lobectomy and segmental pneumonectomy in treatment of early lung cancer[J]. Journal of Clinical Pulmonary Medicine, 2020, 25(5): 740-744. doi: 10.3969/j.issn.1009-6663.2020.05.020
[2]	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. https://www.cnki.com.cn/Article/CJFDTOTAL-TJIY202002017.htm LIU G, WANG LW, DONG L, et al. Comparisons between double-port thoracoscopy-assisted segmental resection and lobectomy in treatment of early non-small cell lung cancer[J]. Journal of Tongji University (Medical Science), 2020, 41(2): 235-239. https://www.cnki.com.cn/Article/CJFDTOTAL-TJIY202002017.htm
[3]	LI L, WANG Y Z. 胸腔镜下肺癌根治术治疗老年非小细胞肺癌的疗效研究[J]. Guide of China Medicine, 2018, 16(19): 45-46. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK202107006.htm
[4]	KANG H R, CHO J Y, LEE S H, et al. Role of low-dose computerized tomography in lung cancer screening among never-smokers[J]. J Thorac Oncol, 2019, 14(3): 436-444. doi: 10.1016/j.jtho.2018.11.002
[5]	LONG H, TAN Q, LUO Q, et al. Thoracoscopic surgery versus thoracotomy for lung cancer: Short-term outcomes of a randomized trial[J]. Ann Thorac Surg, 2018, 105(2): 386-392. doi: 10.1016/j.athoracsur.2017.08.045
[6]	隋天一, 刘傲, 矫文捷. 肺段切除术与肺叶切除术术后肺功能保留的差异[J]. 中国肺癌杂志, 2019, 22(3): 178-182. https://www.cnki.com.cn/Article/CJFDTOTAL-FAIZ201903012.htm SUI T Y, LIU A, JIAO W J. Difference of lung function retention after segmentectomy and lobectomy[J]. Chinese Journal of Lung Cancer, 2019, 22(3): 178-182. https://www.cnki.com.cn/Article/CJFDTOTAL-FAIZ201903012.htm
[7]	王建平, 高杰, 薛恒川, 等. 胸腔镜肺段切除术和肺叶切除术治疗老年早期非小细胞肺癌患者的疗效比较[J]. 实用临床医药杂志, 2020, 24(11): 97-100. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202011026.htm WANG J P, GAO J, XUE H C, et al. Thoracoscopic pulmonary segmentectomy versus lobectomy in the treatment of early non-small cell lung cancer in elderly patients[J]. Journal of Clinical Medicine in Practice, 2020, 24(11): 97-100. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202011026.htm
[8]	王成弟, 陈勃江, 宋璐佳, 等. 23 228例肺癌患者临床流行病学及病理特征趋势分析[J]. 华西医学, 2020, 35(7): 813-820. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX202007012.htm WANG C D, CHEN B J, SONG L J, et al. Epidemiological and pathological distribution characteristics in 23 228 lung cancer patients[J]. West China Medical Journal, 2020, 35(7): 813-820. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX202007012.htm
[9]	许博, 陈献国, 王叶萍, 等. 同期胸腔镜下双侧肺多发结节切除手术40例病例研究[J]. 中华全科医学, 2020, 18(11): 1842-1844, 1965. doi: 10.16766/j.cnki.issn.1674-4152.001633 XU B, CHEN X G, WANG Y P, et al. Simultaneous thoracoscopic bilateral pneumonectomy of multiple pulmonary nodules by with 40 cases[J]. Chinese Journal of General Practice, 2020, 18(11): 1842-1844, 1965. doi: 10.16766/j.cnki.issn.1674-4152.001633
[10]	MARRONE K, ZHANG J, FELICIANO J L, et al. Immune check-point inhibition in elderly non-small cell lung cancer patients[J]. J Clin Oncol, 2018, 36(suppl 5): 137.
[11]	刘宗昂, 张苏宁. 胸腔镜肺段切除术在治疗早期非小细胞肺癌中的应用[J]. 中国医科大学学报, 2019, 48(7): 663-666. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201907020.htm LIU Z A, ZHANG S N. Video-assisted thoracoscopic segmentectomy in the treatment of early-stage non-small cell lung cancer[J]. Journal of China Medical University, 2019, 48(7): 663-666. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201907020.htm
[12]	刘为超, 葛阳, 顾江魁, 等. 胸腔镜肺段与肺叶切除术治疗早期非小细胞肺癌的临床分析[J]. 临床肺科杂志, 2018, 23(5): 921-924. doi: 10.3969/j.issn.1009-6663.2018.05.040 LIU W C, GE Y, GU J K, et al. Clinical analysis of thoracoscopic pulmonary segmentectomy and pulmonary lobectomy in treatment of earlystage non-small cell lung cancer[J]. Journal of Clinical Pulmonary Medicine, 2018, 23(5): 921-924. doi: 10.3969/j.issn.1009-6663.2018.05.040
[13]	魏周斌, 赵亮, 张俣, 等. 胸腔镜肺楔形切除术与胸腔镜肺叶切除加纵隔淋巴结清扫术治疗早期非小细胞肺癌患者的临床效果比较[J]. 现代生物医学进展, 2020, 20(5): 919-922. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202005026.htm WEI Z B, ZHAO L, ZHANG Y, et al. Comparison of the clinical efficacy of thoracoscopic pulmonary wedge resection and thoracoscopic lobectomy plus mediastinal lymphadenectomy in the treatment of early non-small cell lung cancer[J]. Progress in Modern Biomedicine, 2020, 20(5): 919-922. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202005026.htm
[14]	车强, 汪林宝, 王孝彬, 等. 电视胸腔镜下亚肺叶切除术与传统开胸肺叶切除联合淋巴结清扫术对老年早期非小细胞肺癌患者的疗效分析[J]. 癌症进展, 2020, 18(23): 2424-2426, 2438. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202023013.htm CHE Q, WANG L B, WANG X B, et al. Effect of video-assisted thoracoscopic sublobectomy versus traditional open lobectomy both combined with lymph node dissection in senile patients with early non-small cell lung cancer[J]. Oncology Progress, 2020, 18(23): 2424-2426, 2438. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202023013.htm
[15]	王虎, 郝安林, 王卫杰. 胸腔镜下肺段切除术和肺叶切除术治疗肺癌效果对比[J]. 中国医学工程, 2019, 27(2): 62-65. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC201902015.htm WANG H, HAO A L, WANG W J. Comparison of effects of thoracoscopic lobectomy and pulmonary segmentectomy on lung cancer[J]. China Medical Engineering, 2019, 27(2): 62-65. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC201902015.htm
[16]	ZHANG G, YU Z, WANG L, et al. Uniportal video-assisted thoracoscopic S8 segmentectomy and S1a subsegmentectomy for synchronous multiple primary lung cancers[J]. J Thorac Dis, 2018, 10(7): 4475-4480. doi: 10.21037/jtd.2018.06.24
[17]	ABU ARAB W. Video-assisted thoracoscopic surgery for non-small cell lung cancer[J]. Minim Invasive Surg Oncol, 2017, 1(1): 1-11. doi: 10.1007/s11748-018-0979-x
[18]	XUE L, FAN H, SHI W, et al. Preoperative 3-dimensional computed tomography lung simulation before video-assisted thoracoscopic anatomic segmentectomy for ground glass opacity in lung[J]. J Thorac Dis, 2018, 10(12): 6598.
[19]	李小军, 朱潇, 杏福宝, 等. 三维重建及3D打印在微创肺外科中的应用[J]. 中华全科医学, 2020, 18(7): 1190-1194. doi: 10.16766/j.cnki.issn.1674-4152.001462 LI X J, ZHU X, XING F B, et al. Application of three-dimensional reconstruction and 3D printing in minimally invasive lung surgery[J]. Chinese Journal of General Practice, 2020, 18(7): 1190-1194. doi: 10.16766/j.cnki.issn.1674-4152.001462
[20]	唱宽, 毛志刚, 舒健. 微创肺段切除术治疗早期非小细胞肺癌的可行性和有效性[J]. 癌症进展, 2020, 18(6): 606-609. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202006019.htm CHANG K, MAO Z G, SHU J. Evaluation of feasibility and efficacy of video-assisted thoracoscopic segmentectomy for early stage non-small cell lung cancer[J]. Oncology Progress, 2020, 18(6): 606-609. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202006019.htm
[21]	王进, 戚剑伟, 火旭东, 等. 胸腔镜肺段切除术治疗Ⅰ期非小细胞肺癌的近远期疗效观察[J]. 川北医学院学报, 2019, 34(5): 628-631. https://www.cnki.com.cn/Article/CJFDTOTAL-NOTH201905037.htm WANG J, QI J W, HUO X D, et al. Observation on short-term and long-term efficacy of thoracoscopic segmental resection for stage Ⅰ non-small cell lung cancer[J]. Journal of North Sichuan Medical College, 2019, 34(5): 628-631. https://www.cnki.com.cn/Article/CJFDTOTAL-NOTH201905037.htm