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目的评估肺段切除的手术安全性及治疗早期非小细胞肺癌的预后。方法回顾性分析2007年1月至2012年12月我科肺段切除治疗肺部良恶性疾病患者88例的临床资料,其中男45例、女43例,肺段切除术组29例,肺叶切除术组59例。将肺段切除治疗非小细胞肺癌患者与同期肺叶切除非小细胞肺癌患者进行频数匹配。对围手术期因素、肿瘤相关预后进行分析。结果肺段切除平均手术时间210 min;术中出血量166 ml;术后胸腔引流量2 147 ml,术后拔管时间6 d。组间比较结果显示肺段切除术治疗肺良、恶性疾病的手术时间(P>0.999)、术中出血量(P=0.207)、术后胸腔引流量(P=0.946)、拔管时间(P=0.804)及术后并发症(P>0.999)等差异均无统计学意义。与肺叶切除术相比,肺段切除术治疗早期非小细胞肺癌手术时间(P=0.462)、术中出血量(P=0.783)、术后拔管时间(P=0.072)、术后并发症(P>0.999)、复发及转移率(P=0.417)等差异均无统计学意义,但肺段切除术组N1淋巴结清扫个数(P=0.033)及站数(P=0.024)要少于肺叶切除术组,且差异有统计学意义。随访终点两组无瘤生存率(P=0.373)及总生存率(P=0.340)差异无统计学意义。结论肺段切除术安全可行,适用于肺良性疾病位置较为局限的患者以及部分肺功能欠满意的早期非小细胞肺癌患者。
Objective To assess the surgical safety of resection of the segmentectomy and the prognosis of early stage non-small cell lung cancer. Methods The clinical data of 88 patients with benign and malignant lung diseases undergoing lung resection from January 2007 to December 2012 were retrospectively analyzed. There were 45 males and 43 females, 29 segmentectomy groups and lobectomy Surgery in 59 cases. The resection of the lung segment for non-small cell lung cancer patients with concurrent lobectomy non-small cell lung cancer patients frequency matching. Perioperative factors, tumor-related prognosis analysis. Results The average operative time of segmentectomy was 210 min. The intraoperative blood loss was 166 ml. The postoperative thoracic drainage volume was 2 147 ml. The postoperative extubation time was 6 days. The comparison of the results between the two groups showed that operative time (P> 0.999), intraoperative blood loss (P = 0.207), postoperative thoracic drainage (P = 0.946), extubation time = 0.804) and postoperative complications (P> 0.999) and other differences were not statistically significant. Compared with lobectomy, segmentectomy for the treatment of early non-small cell lung cancer (P = 0.462), intraoperative bleeding (P = 0.783), postoperative extubation time (P = 0.072), postoperative complications (P> 0.999), recurrence and metastasis (P = 0.417), but the number of N1 lymph node dissection (P = 0.033) and the number of stations (P = 0.024) in segmentectomy group were less than Lobectomy group, and the difference was statistically significant. There was no significant difference between the two groups in the no-tumor survival (P = 0.373) and overall survival (P = 0.340) at the end of follow-up. Conclusions Segment resection is safe and feasible. It is suitable for patients with relatively limited pulmonary benign disease and some patients with early stage non-small cell lung cancer who are not satisfied with pulmonary function.