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目的:评价非小细胞肺癌微创手术与开放手术的围术期相关并发症和总体生存情况。方法:回顾性分析我院2009年7月至2013年12月间187例非小细胞肺癌手术患者的临床资料,其中微创手术组95例,开放手术组92例,比较两组手术的围术期相关指标和总生存情况。结果:患者均顺利完成手术,无手术死亡病例。两组在手术时间、术中出血量以及淋巴结清扫个数方面无明显差别;微创手术组术后第1、2天疼痛明显减轻(POD1:3.1±0.8 vs 3.9±0.9,P=0.03;POD2:2.7±0.6 vs 3.5±0.5,P=0.018),术后3 d胸管引流总量减少(410±160 vs 710±208,P=0.01)、胸管留置时间缩短(5.2±1.5 vs 7.5±1.0,P=0.028)、围手术期总并发症减少(22.5%vs 51%,P=0.01)。随访6~48个月,微创手术组总生存率略优于开放手术组,但两组间差异无统计学意义(79.0%vs 75.6%,P>0.05)。结论:对于非小细胞肺癌,全胸腔镜解剖性肺叶切除术优于传统开放手术,前者并不增加手术时间以及术中出血,达到同样淋巴结清扫效果,有效减轻术后疼痛、胸管留置时间、胸管引流量以及围手术期并发症;而患者术后远期生存获益方面仍需进一步研究。
PURPOSE: To evaluate the perioperative complications and overall survival of minimally invasive and open surgery for non-small cell lung cancer. Methods: The clinical data of 187 patients with non-small cell lung cancer from July 2009 to December 2013 in our hospital were retrospectively analyzed. Among them, 95 patients in minimally invasive surgery group and 92 patients in open surgery group were compared. Related indicators and overall survival. Results: All patients successfully completed the operation without any surgical deaths. There was no significant difference between the two groups in operation time, blood loss in operation and the number of lymph node dissection. The pain relief was significantly reduced in the minimally invasive surgery group (POD1: 3.1 ± 0.8 vs 3.9 ± 0.9, P = 0.03; POD2 (P <0.01). The total chest tube drainage decreased 3 days after operation (410 ± 160 vs 710 ± 208, P = 0.01) 1.0, P = 0.028). The total perioperative complications decreased (22.5% vs 51%, P = 0.01). After 6 months to 48 months of follow-up, the overall survival rate in minimally invasive surgery group was slightly better than that in open surgery group, but there was no significant difference between the two groups (79.0% vs 75.6%, P> 0.05). Conclusions: Total thoracoscopic anatomic lobectomy is superior to traditional open surgery for non-small cell lung cancer, the former does not increase the operation time and intraoperative bleeding, to achieve the same lymph node dissection, reduce postoperative pain, chest tube indwelling time, Chest tube drainage and perioperative complications; and patients with long-term survival benefit need further study.