cN0-pN2非小细胞肺癌行全胸腔镜肺叶切除手术初步体会

被引：8

作者：

卜梁

杨帆

赵辉

李运

姜冠潮

李剑锋

刘军

王俊

机构：

[1] 北京大学人民医院胸外科

来源：

中华胸心血管外科杂志 | 2011年 / 08期

关键词：

癌,非小细胞肺; 肿瘤分期; 胸腔镜检查;

D O I：

暂无

中图分类号：

R734.2 [肺肿瘤];

学科分类号：

100214 ;

摘要：

目的探讨术前临床分期N0术后病理分期N2的非小细胞肺癌患者行全胸腔镜肺叶切除手术的可行性。方法 2006年9月至2010年1月施行全胸腔镜肺叶切除治疗非小细胞肺癌216例中术前临床分期N0患者206例,男103例,女103例;年龄29～85岁,平均(62.3±11.1)岁。按术后病理纵隔淋巴结是否转移分为pN0组(168例,无纵隔淋巴结转移)和pN2组(38例,存在纵隔淋巴结转移)。回顾性分析两组病例年龄、性别、肿瘤大小、位置、病理类型、分化程度、中转开胸、手术时间、术中出血、淋巴结清扫情况、引流时间、住院时间及并发症等围手术期数据。结果 206例中肺叶切除203例,复合肺叶切除2例,全肺切除1例,手术过程顺利。无严重围手术期并发症,围手术期死亡1例(肺部感染至呼吸功能衰竭)。两组年龄、性别分布差异无统计学意义。pN0组肿瘤最大径明显小于pN2组[(2.6±1.6)cm对(3.7±1.9)cm,P=0.001]。pN0组肿瘤位于下叶者明显少于pN2组(31.0%对50.0%,P=0.026)。两组腺癌比例无统计学意义(82.7%对73.7%,P=0.181),但pN0组低分化癌比例明显低于pN2组(19.0%对42.1%,P=0.002)。两组中转开胸率(7.1%对7.9%,P=1.000)、手术时间[(196.1±53.7)min对(208.6±56.8)min,P=0.202]、术中出血量[(253.2±247.9)ml对(279.0±183.3)ml,P=0.475]、术后引流时间[(7.7±3.2)天对(9.7±6.3)天,P=0.066]、住院时间[(10.6±4.6)天对(13.0±7.6)天,P=0.063]、并发症发生率(12.5%对21.1%,P=0.171)组间和纵隔淋巴结清扫站数[(3.1±1.2)对(3.3±1.1),P=0.237],差异无统计学意义。pN0组纵隔淋巴结清扫枚数少于pN2组[(9.9±6.8)对(12.7±8.4)枚,P=0.038]。结论术前N0分期术后病理N2分期的非小细胞肺癌患者行全胸腔镜肺叶切除手术是安全可行的。

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