VATS 与开胸肺癌根治术治疗Ⅰ期非小细胞肺癌近期效果比较

摘要

目的：对比分析电视辅助胸腔镜手术（video - assisted thoracic surgery，VATS）与开胸肺癌根治术对Ⅰ期非小细胞肺癌（NSCLC）的临床近期疗效。方法：选择Ⅰ期 NSCLC 75例，分为 VATS 组（n =36）和开胸组（n=39），对两组手术、实验室、生活质量指标进行比较。结果：术中出血量、引流量、术后首次下床时间、术后住院时间：胸腔镜组为（102±28.9）ml、（254±56.3）ml、（2±0.8）d、（10±2.3）d 明显低于开胸组（174±25.7） ml、（405±46.8）ml、（4±0.9）d、（13±1.7）d，差异有统计学意义（P <0.05）。淋巴结清扫、术后复发、转移两组无明显差异（P >0.05）。超敏 C 反应蛋白两组均较术前增高，而胸腔镜组术后3d（9.32±1.75）mg/ L 明显低于开胸组（10.57±2.25）mg/ L（P <0.05）。两组 FEV1均较术前降低，但胸腔镜组（1.67±0.14）L/ min 明显高于开胸组（1.59±0.18）L/ min（P <0.05）。两组术后生活质量得分均较术前高，但胸腔镜组（117.6±6.43）分明显高于开胸组（113.2±4.83）分（P <0.05）。结论：VATS 治疗Ⅰ期 NSCLC 创伤小，术后生活质量高于常规开胸术。%Objective:To compare the early clinical effects of patients with stage I NSCLC treated by VATS and thoracotomy. Methods:Totally 75 cases of NSCLC in stage I were randomly divided into two groups:VATS group(n= 36)and thoracotomy group(n = 39). The operative index,laboratory parameters and quality of life were observed. Results:Blood loss,chest tube drainage,postoperative ambulation first time,postoperative hospital stay in the VATS group were(102 ± 28. 9)ml,(254 ± 56. 3)ml,(2 ± 0. 8)d,(10 ± 2. 3)d significantly lower than those(174 ± 25. 7) ml,(405 ± 46. 8)ml,(4 ± 0. 9)d,(13 ± 1. 7)d of thoracotomy group(P < 0. 05). There was no difference of lymph node dissection and postoperative recurrence between the two groups(P > 0. 05). The blood amount of high - sensi-tivity C - reactive protein was(9. 32 ± 1. 75)mg/ L on the 3rd postoperative day in the VATS significantly lower than that of thoracotomy group(10. 57 ± 2. 25)mg/ L,P < 0. 05. After surgery 1 ,3 ,6 months,the FEV1 of patients was (1. 67 ± 0. 14)L/ min in VATS group significantly higher than thoracotomy group(1. 59 ± 0. 18)L/ min(P < 0. 05). The score of postoperative quality of life was 117. 6 ± 6. 43 in VATS group significantly higher than 113. 2 ± 4. 83 in the thoracoscopic group(P < 0. 05). Conclusion:VATS is superio to thoraocotomy for stage I NSCLC with minimum injury and better post operative quality of life.