【摘要】：目的:回顧性分析全胸腔鏡下非小細胞肺癌縱隔淋巴結清掃的圍手術期資料,以同期傳統(tǒng)開胸手術病例作對照,對比研究兩種手術方式下縱隔淋巴結清掃的差異性以及清掃后并發(fā)癥的發(fā)生率情況。方法:選取2010年1月至2015年7月湖州市中心醫(yī)院胸心外科非小細胞肺癌患者經(jīng)手術治療者的圍手術期資料,其中497例行肺葉切除+系統(tǒng)性縱隔淋巴結清掃者作為研究對象,按照手術方式不同分為全胸腔鏡手術(觀察組)242例和傳統(tǒng)開胸手術(對照組)255例。采用傾向得分匹配法對兩組基線資料進行1:1匹配,比較配比后兩組在圍手術期參數(shù)、病理類型、縱隔淋巴結清掃數(shù)情況及cN0-pN2比例等方面的差異。結果:本研究共納入497例行肺葉切除+系統(tǒng)性縱隔淋巴結清掃的非小細胞肺癌病例,其中觀察組242例,對照組255例,采用傾向得分匹配法完成匹配376例,每組188例,配比后兩組基線資料比較差異無顯著性,P0.05;觀察組與對照組比較:平均縱隔淋巴結清掃組數(shù)為4.14±0.57組比3.97±0.62組(F=7.28,P0.01);平均縱隔淋巴結清掃枚數(shù)為16.63±4.84枚比17.32±3.63枚(F=2.46,P=0.12);左側肺癌第7組淋巴結清掃枚數(shù)為7.25±2.13比8.78±2.91,F=10.98,P0.01),其余部位清掃枚數(shù)差異無顯著性(P0.05);兩組總轉移率為3.84%比4.33%(x2=0.98,P=0.32),總轉移度為8.23%比7.36%(x2=0.39,P=0.52);術后病理[腺癌(67.55%比68.62%,X2=0.05,P=0.82),鱗癌(22.34%比23.94%比,X2=0.13,P=0.71),其他類型(10.11%比7.44%,X2=0.83,P=0.36)];手術時間[(153.24±21.91)min比(162.23±22.75)min,F=15.23,P＜0.01];術中失血[(158.51±95.39)ml比(166.49±104.03)ml,F=0.60,P=0.44];手術副損傷[氣管損傷(1.59%比2.13%,X2=0.15,P=0.70),食管損傷(0.53%比 1.06,X2=0.34,P=0.56),喉返神經(jīng)損傷(2.66%比 1.59%,X2=0.51,P=0.47),胸導管損傷,1.06%比0.53%,X2=0.34,P=0.56),大血管損傷(3.19%比2.13%,X2=0.41,P=0.52);術后24小時引流量[(252.85±129.81)ml比(258.19±105.34)ml,F=0.11,P=0.74];術后并發(fā)癥[聲音嘶啞(4.26%比3.72%,X2=0.07,P=0.79),心律失常(2.66%比3.19%,X2=0.09,P=0.76),乳糜胸(1.59%比2.13%,X2=0.34,P=0.56)];術后住院天數(shù)[(9.02±3.61)d比(10.18±3.97)d,F=8.85,P0.01]。結論:全胸腔鏡下非小細胞肺癌縱隔淋巴結清掃手術在術后恢復、并發(fā)癥及住院天數(shù)方面存在優(yōu)勢,手術風險未明顯增加,總體縱隔淋巴結清掃有效性與傳統(tǒng)開胸手術相當,但左側肺癌行第7組淋巴結清掃能力差于傳統(tǒng)開胸手術。
[Abstract]:Objective: to analyze retrospectively the perioperative data of mediastinal lymph node dissection in non-small cell lung cancer (NSCLC) under total thoracoscopy, and to compare the data of the patients with traditional thoracotomy in the same period. To compare the difference of mediastinal lymph node dissection and the incidence of complications after dissection. Methods: the perioperative data of patients with non-small cell lung cancer (NSCLC) in thoracic and cardiac surgery of Huzhou Central Hospital from January 2010 to July 2015 were selected. 497 patients underwent systemic mediastinal lymph node dissection after lobectomy. There were 242 cases of total thoracoscopic surgery (observation group) and 255 cases of traditional thoracotomy (control group). The baseline data of the two groups were matched by inclination score matching method at 1:1. The differences of perioperative parameters pathological types mediastinal lymph node dissection and cN0-pN2 ratio between the two groups were compared after matching. Results: 497 cases of non-small cell lung cancer with systemic mediastinal lymph node dissection were included in this study, including 242 cases in the observation group and 255 cases in the control group. 376 cases (188 cases in each group) were matched by tendency score matching method. After matching, there was no significant difference in baseline data between the two groups (P 0.05); the average number of mediastinal lymph node dissection was 4.14 鹵0.57 vs 3.97 鹵0.62 in the observation group and 3.97 鹵0.62 in the control group, 16.63 鹵4.84 in the average mediastinal lymph node dissection vs 17.32 鹵3.63 in the control group, and 7 in the left lung cancer. 緇勬穻宸寸粨娓呮壂鏋氭暟涓，

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