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目的 评价电视辅助胸腔镜手术(VATS)治疗临床I期非小细胞肺癌(NSCLC)的疗效和安全性.方法 行肺叶切除术的I期NSCLC病人185例,根据病人的手术方式不同将病人分为VATS肺叶切除术组(VATS组)与常规开胸肺叶切除术组(开胸组),比较两组病人的临床资料、无病生存率(DFS)与总生存率(OS),采用Cox回归分析评价影响病人DFS与OS的预测因素.结果 非小细胞肺癌病人185例,行VATS肺叶切除术87例,行常规开胸肺叶切除术98例.开胸组、VATS组手术时间分别为(124.39±28.97)分钟和(116.47±30.63)分钟,两组比较差异无统计学意义(P＞0.05);住院时间分别为(10.28±3.61)天和(12.82±4.77)天,肺部并发症发生率分别为13.2％和26.5％,两组比较差异有统计学意义(P＜0.05).淋巴结取样数分别为(7.09±1.81)个和(8.13 ±1.74)个,N2纵隔淋巴结取样数分别为(2.25±0.58)个和(2.56 ±0.66)个,两组比较差异无统计学意义(P＞0.05).VATS组病人5年DFS和OS分别为57.8％和74.7％,开胸组分别为46.9％、62.2％,差异有统计学意义(P＜0.05).Cox回归分析显示,肿瘤体积较大是DFS与OS较差的预测因子.结论 VATS肺叶切除术可安全有效地治疗临床I期NSCLC,与开胸肺叶切除术比较,VATS组病人住院时间短,肺部并发症少.淋巴结切除术结果和预后与接受开胸手术病人相当.“,”Objective To evaluate the efficacy and safety of video-assisted thoracoscopic surgery (VATS) in the treatment of clinical stage I non-small cell lung cancer (NSCLC). Methods 185 patients with stage I NSCLC who underwent lobectomy in our hospital were retrospectively analyzed. The patients were divided into VATS lobectomy group (the VATS group) and Conventional lobectomy group (the thoracotomy group) according to different surgical methods. The clinical data, disease-free survival (DFS) and overall survival(OS) were compared between the two groups. Cox regression analysis was used to predict the predictors of DFS and OS in the patients. Results A total of 185 patients were enrolled, 87 (47％) patients underwent VATS lobectomy, and 98 (53％) patients underwent conventional thoracotomy lobectomy. Compared with the thoracotomy group, the operation time of VATS group was longer, but the difference was not statistically significant([ 124.39±28.97) min vs. (116.47 ± 30.63) min, t= 1.801, P=0.073], the hospitalization time was significantly shortened [(10.28 ± 3.61) d vs. (12.82 ±4.77) d, t=4.041, P＜0.001 ], the incidence of pulmonary complications was significantly decreased[ 13.2％ (11/87)vs.26.5％(26/98), χ2=5.555, P =0.018], The number of lymph nodes[(7.09 ± 1.81)vs. (8.13±1.74), t = 1.302, P=0.195] and the number of N2 mediastinal lymph nodes [(2.25 ±0.58) vs. (2.56±0.66), t = 1.524, P=0.129] were similar. In VATS group, 5 year DFS(57.8％ vs.46.9％, logrank P =0.014) and OS(74.7％ vs.62.2％, logrank P = 0.018) were significantly improved. Cox regression analysis showed that larger tumor volume was a poor predictor of DFS and OS. Conclusion VATS lobectomy is a safe and effective treatment for stage I non-small cell lung cancer. Compared with conventional thoracotomy, VATS patients have shorter hospitalization time and less pulmonary complications, and lymph node resection results and tumor prognosis are comparable to those undergoing conventional thoracotomy lobectomy.