全胸腔镜肺叶切除术中肺动、静脉切断顺序对早期非小细胞肺癌疗效的影响

摘要

目的 探讨全胸腔镜下肺叶切除术中肺动、静脉切断顺序对Ⅰ～Ⅱ期非小细胞肺癌疗效的影响.方法 回顾分析2006年9月至2012年12月行肺叶切除的1134例患者中直接行全胸腔镜下肺叶切除术,且术后病理证实为Ⅰ～Ⅱ期非小细胞肺癌者277例的资料.根据血管处理顺序分为先断静脉组(Group V) 152例、先断动脉组(Group A)76例、动脉-静脉-动脉混合离断组(Group M)49例.比较3组术前、术中情况及术后生存、复发情况.结果 3组性别分布、年龄、吸烟史、肺部感染史、主要并发症、既往肿瘤病史、病变直径、术前肿瘤标志物及术前肺功能相似.Group A组平均术中出血109.9ml,明显少于Group V组的157.5ml,而Group M介于两者之间为123.7 ml(P=0.027).3组手术时间、术后并发症情况相似;肿瘤复发方式相似,均以远处转移为主;无瘤生存时间及总生存时间差异均无统计学意义.结论 对于全胸腔镜下治疗Ⅰ～Ⅱ期非小细胞肺癌,先处理并切断动脉可减少术中出血,并未减少手术难度和术后并发症;血管处理顺序不影响肿瘤复发、转移和生存,可根据术中需要合理选择.%Objective To study the correlation between prognosis and the sequence of vessel interruption during thoracoscopic lobectomy for early stage non-small cell lung cancer.Methods Retrospective analysis of the 1 134 cases underwent lobectomy between September 2006 and October 2012 was conducted.There were 277 cases underwent completely thoracoscopic lobectomy and confirmed as stage Ⅰ-Ⅱ non-small cell lung cancer by pathology.The cases were divided into three groups according to the vessel interruption sequence:pulmonary vein ligated first(Group V) 152 cases,pulmonary artery ligated first (Group A) 76 cases,and artery-vein-artery group(Group M) 49 cases.The preoperative condition,operative factors and the prognosis of the three groups were reviewed.All of the data for statistical analysis,count data by chi-square test.Measurement data using t test,Kaplan-Meier method applied survival analysis,Log-rank test and Cox regression model analysis for single factor and multiple factors.Results The groups were similar in age,sex,smoking history,pulmonary infection history,main comorbidity,malignant history,diameter,tumor maker and preoperative lung function.The blood loss during the operation is 109.9 ml in Group A,which is significantly less than Group V (157.5 ml),and Group M had the median blood loss 123.7 ml (P =0.027).The length of operation and postoperative complications were similar among the three groups.The recurrent conditions were also similar among the three groups,which were mostly distant metastasis.There was no significant difference statistically in disease free survival(DFS) and overall survival(OS) among the three groups.Conclusion Ligating the pulmonary artery first could decrease the blood loss during completely thoracoscopic lobectomy for stage Ⅰ-Ⅱ non-small cell lung cancer.But it did not have any influence on the surgical difficulty and postoperative complications.The sequence of vessel interruption during lobectomy by thoracoscopic surgery did not have difference effect on the prognosis of lung cancer.