【摘要】 目的总结连续300例行全胸腔镜(VATS)肺叶切除术患者的临床经验,并报道其3年随访结果。方法回顾性分析北京大学人民医院胸外科2006年9月至2009年12月期间完成的连续300例行VATS肺叶切除术患者的临床资料,其中男159例,女141例;年龄18~86岁(58.30±13.90岁)。术前临床诊断:肺占位266例,支气管扩张22例,囊肿/脓肿5例,肺隔离症3例,真菌感染2例,气胸2例。对其手术相关参数及3年随访结果等进行统计分析。结果全组300例患者中良性疾病66例,其中感染性疾病占81.82%(54/66);恶性疾病234例,其中非小细胞肺癌213例,腺癌占全部恶性疾病的73.08%(171/234)。全组273例完成VATS手术,27例中转开胸,中转开胸率9.00%。完成VATS肺叶切除手术时间3.17±0.88 h,术中出血量225.70±195.20 ml。良性疾病患者的手术时间、术后胸腔引流时间均显著低于恶性疾病(t=2.280,P=0.003;t=1.392,P=0.030)。中转开胸的主要原因为淋巴结与血管致密粘连,占62.96%(17/27);其它原因主要为术中出血,占18.52%(5/27)。单因素分析结果显示:肺上叶切除术中转开胸风险高于非上叶切除术(χ2=6.131,P=0.013),而患者性别(χ2=1.182,P=0.277),良、恶性疾病(χ2=0.210,P=0.647),病变位于左右侧(2χ=2.933,P=0.087)之间中转开胸风险的差异无统计学意义。全组患者3年随访结果显示:良性疾病患者无症状复发,非小细胞肺癌患者3年总生存率为0.87[95%CI(0.77,0.96)],其中病理分期Ⅰ期患者(135例)3年总生存率为0.91[95%CI(0.85,0.98)]。结论 VATS肺叶切除术是一种安全有效的手术方式,国内VATS肺叶切除术技术及中期效果均达到了国际水平。更多还原

【Abstract】 Objective To summarize the clinical experiences of video-assisted thoracoscopic surgery(VATS) lobectomy performed on a series of 300 consecutive patients,and report the results of a 3-year follow-up.Methods We retrospectively analyzed the clinical data of 300 consecutive patients who underwent VATS lobectomy from September 2006 to December 2009 in the Department of Thoracic Surgery,People’s Hospital of Peking University.Of the 300 patients,there were 159 males and 141 females with the age ranged from 18 to 86 years(58.30±13.90 years).Preoperative diagnosis showed that there were 266 patients of mass in the lung,22 of bronchiectasis,5 of cyst/abscess in the lung,3 of pulmonary sequestration,2 of fungus infection,and 2 of pneumothorax.We assessed the peri-operative variables by standard descriptive statistics and estimated the 3-year survival rate by Kaplan-Meier analyses.Results Sixty-six patients were diagnosed to have benign diseases and 234 patients were with malignancies.A percentage of 81.82%(54/66) of the benign patients had infectious diseases,and the majority of the malignancies was non-small cell lung cancer(213 patients),especially adenocarcinomas which comprised 73.08%(171/234) of all the malignancies.A total of 273 patients accomplished VATS lobectomy,of whom 27 patients required conversion to thoracotomy at a conversion rate of 9.00%(27/300).In the VATS lobectomy accomplished group,the mean operation time was 3.17±0.88 h,and the blood loss was 225.70±195.20 ml.Benign surgery took significantly less time(t=2.280,P=0.0032) and had shorter drainage time(t=1.392,P=0.0304) than those of malignancies.Dense adhesions between lymph nodes and blood vessels was the primary reason for conversion to thoracotomy in 17 patients at a percentage of 62.96%(17/27).Bleeding was the second reason for conversion in 5 patients at a percentage of 18.52%.The patients in the upper lobe lobectomy group showed significantly higher risk of conversion compared with those in the non-upper lobe surgery group(χ2=6.131,P=0.013),while gender(χ2=1.182,P=0.277),pathology(χ2=0.210,P=0.647) and the tumor located in left or right side(χ2=2.933,P=0.087) didn’t influence the risk of conversion.The result of the 3-year follow-up showed that there was no reoccurrence of symptoms in patients with benign diseases;Non-small cell lung cancer patients had a 3-year survival rate of 0.87 with the 95% confidence interval(CI) from 0.77 to 0.96,and pathologic stage I patients at 0.91 with the 95%CI from 0.85 to 0.98.Conclusion VATS lobectomy is safe and effective.This research shows that domestic technologies of VATS lobectomy and its mid-term results have reached the international standard.更多还原