全胸腔镜手术治疗高龄全胸腔镜手术治疗高龄Ⅰa～Ⅲa期肺癌患者的疗效及生存分析
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摘要
目的探讨全胸腔镜手术治疗高龄Ⅰa～Ⅲa期肺癌患者的疗效及生存情况。方法根据手术方法的不同将行手术切除的96例高龄(年龄﹥75岁且﹤85岁)Ⅰa～Ⅲa期原发性肺癌患者分为观察组(n=48)和对照组(n=48)。观察组患者行全胸腔镜下肺叶切除术,对照组患者行开胸肺叶切除术,比较两组患者的手术相关指标、术后并发症发生情况及1年生存情况。结果观察组患者的手术时间、术后下床活动时间均明显短于对照组,术中出血量、术后引流量均明显低于对照组,差异均有统计学意义(P﹤0.01);观察组和对照组患者的手术根治率、淋巴结清扫数目、拔管时间比较,差异均无统计学意义(P﹥0.05);观察组患者的术后并发症总发生率明显低于对照组(P﹤0.01);两组患者的1年生存率比较,差异无统计学意义(P﹥0.05)。结论全胸腔镜手术治疗高龄Ⅰa～Ⅲa期肺癌患者的疗效与传统开胸手术相当,且不良反应发生少,对患者的影响较小,更有利于患者的术后恢复。
Objective To investigate the clinical efficacy of complete thoracoscopic surgery for elderly patients with stage Ⅰa-Ⅲa lung cancer and their survival situation. Method A total of 96 elderly patients(>75 years and <85 years)with primary lung cancer staging Ⅰa to Ⅲa were selected and divided into observation group(n=48) and control group(n=48) according to the operative methods they accepted. The observation group underwent complete thoracoscopic lobectomy and the control group underwent conventional thoracotomy lobectomy. The surgery related indicators, incidence of complications and 1-year survival were compared between the two groups. Result The operation time and the postoperative out-of-bed ambulation time in observation group were shorter than those in control group, and the volume of intraoperative blood loss and postoperative suction drainage were less than those in control group, the differences were statistically significant(P<0.01). The radical operation success rate, number of lymph node dissection and extubation time between the two groups showed no significant difference(P>0.05). The postoperative complications rate in observation group was significant lower than that in control group(P<0.01). There was no significant difference in 1-year survival between the two groups(P>0.05). Conclusion The clinical efficacy of complete thoracoscopic lobectomy in the treatment of elderly patients with stage Ⅰa-Ⅲa lung cancer is comparable to that of traditional thoracotomy. Thoracoscopic lobectomy is conducive to postoperative recovery of patient with less adverse events and less influence.
Objective To investigate the clinical efficacy of complete thoracoscopic surgery for elderly patients with stage Ⅰa-Ⅲa lung cancer and their survival situation. Method A total of 96 elderly patients(>75 years and <85 years)with primary lung cancer staging Ⅰa to Ⅲa were selected and divided into observation group(n=48) and control group(n=48) according to the operative methods they accepted. The observation group underwent complete thoracoscopic lobectomy and the control group underwent conventional thoracotomy lobectomy. The surgery related indicators, incidence of complications and 1-year survival were compared between the two groups. Result The operation time and the postoperative out-of-bed ambulation time in observation group were shorter than those in control group, and the volume of intraoperative blood loss and postoperative suction drainage were less than those in control group, the differences were statistically significant(P<0.01). The radical operation success rate, number of lymph node dissection and extubation time between the two groups showed no significant difference(P>0.05). The postoperative complications rate in observation group was significant lower than that in control group(P<0.01). There was no significant difference in 1-year survival between the two groups(P>0.05). Conclusion The clinical efficacy of complete thoracoscopic lobectomy in the treatment of elderly patients with stage Ⅰa-Ⅲa lung cancer is comparable to that of traditional thoracotomy. Thoracoscopic lobectomy is conducive to postoperative recovery of patient with less adverse events and less influence.
引文
[1]李营,韩宝惠.多原发肺癌诊治新进展[J].临床肿瘤学杂志, 2014, 19(10):953-956.
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[5]胡红军.胸腔镜与开胸手术对老年肺癌患者临床应用效果的比较[J].中国老年学杂志, 2014, 34(20):5887-5888.
[6]张艳娇,高禹舜.胸腔镜手术治疗肺癌的现状及趋势[J].肿瘤学杂志, 2014, 20(10):800-805.
[7] Shao W, Liu J, Liang W, et al. Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer[J]. Chin J Cancer Res, 2014, 26(4):418-422.
[8]王丽.中国原发性肺癌诊疗规范(2015年版)解读[J].世界临床药物, 2016, 37(7):433-436.
[9]张用,毕建平,皮国良,等.国际肺癌研究协会第八版国际肺癌TNM分期修订稿解读[J].肿瘤防治研究, 2016, 43(4):313-318.
[10]姚晓军,刘伦旭.肺癌的流行病学及治疗现状[J].现代肿瘤医学, 2014, 22(8):1982-1986.
[11] Wang Y. Video-assisted thoracoscopic surgery for nonsmall-cell lung cancer is beneficial to elderly patients[J].Int J Clin Exp Med, 2015, 8(8):13604-13609.
[12]赵霖,吴琼.手术治疗70岁以上高龄肺癌患者的临床效果分析[J].实用临床医药杂志, 2015, 19(9):157-160.
[13]余忠林,袁德武.全胸腔镜肺叶切除术治疗高龄非小细胞肺癌近期效果及远期预后生存分析[J].解放军医药杂志, 2018, 30(1):34-37.
[14]卢星照,杜巍,周建平,等.全胸腔镜手术治疗Ⅰ~ⅡA期周围型肺癌效果探讨[J].现代诊断与治疗, 2017, 28(7):1249-1251.
[15] Luo QQ, Lin H, Tan Q, et al. Analysis of clinical application of thoracoscopic lobectomy for lung cancer[J]. World J Surg Oncol, 2014, 12:157.
[16]武国栋,张毅,钱坤,等.胸腔镜肺段切除术治疗60岁以上ⅠA期非小细胞肺癌的近期疗效[J].中国微创外科杂志, 2017, 17(1):15-18.
[17]韦武芝,刘宝珊,曾贵青,等.胸腔镜肺叶切除术在70岁以上肺癌患者的应用[J].中华全科医学, 2015, 13(3):381-383.
[18]李新宇,张海云,何荣琦,等.胸腔镜下行肺癌根治术的临床疗效及安全性观察[J].实用医学杂志, 2015, 31(6):962-963.
[2]高禹舜,陈骏,于磊.肺癌临床多学科综合诊断与鉴别诊断[M].北京:军事医学科学出版社, 2015:59-62.
[3]陈汉春,胡维新.环境因素对肺癌发生的影响[J].生命科学研究, 2006, 10(2):112-114.
[4]赵伍忠,贺跃.肺癌外科手术治疗进展[J].湖北民族学院学报(医学版), 2016, 33(3):78-79.
[5]胡红军.胸腔镜与开胸手术对老年肺癌患者临床应用效果的比较[J].中国老年学杂志, 2014, 34(20):5887-5888.
[6]张艳娇,高禹舜.胸腔镜手术治疗肺癌的现状及趋势[J].肿瘤学杂志, 2014, 20(10):800-805.
[7] Shao W, Liu J, Liang W, et al. Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer[J]. Chin J Cancer Res, 2014, 26(4):418-422.
[8]王丽.中国原发性肺癌诊疗规范(2015年版)解读[J].世界临床药物, 2016, 37(7):433-436.
[9]张用,毕建平,皮国良,等.国际肺癌研究协会第八版国际肺癌TNM分期修订稿解读[J].肿瘤防治研究, 2016, 43(4):313-318.
[10]姚晓军,刘伦旭.肺癌的流行病学及治疗现状[J].现代肿瘤医学, 2014, 22(8):1982-1986.
[11] Wang Y. Video-assisted thoracoscopic surgery for nonsmall-cell lung cancer is beneficial to elderly patients[J].Int J Clin Exp Med, 2015, 8(8):13604-13609.
[12]赵霖,吴琼.手术治疗70岁以上高龄肺癌患者的临床效果分析[J].实用临床医药杂志, 2015, 19(9):157-160.
[13]余忠林,袁德武.全胸腔镜肺叶切除术治疗高龄非小细胞肺癌近期效果及远期预后生存分析[J].解放军医药杂志, 2018, 30(1):34-37.
[14]卢星照,杜巍,周建平,等.全胸腔镜手术治疗Ⅰ~ⅡA期周围型肺癌效果探讨[J].现代诊断与治疗, 2017, 28(7):1249-1251.
[15] Luo QQ, Lin H, Tan Q, et al. Analysis of clinical application of thoracoscopic lobectomy for lung cancer[J]. World J Surg Oncol, 2014, 12:157.
[16]武国栋,张毅,钱坤,等.胸腔镜肺段切除术治疗60岁以上ⅠA期非小细胞肺癌的近期疗效[J].中国微创外科杂志, 2017, 17(1):15-18.
[17]韦武芝,刘宝珊,曾贵青,等.胸腔镜肺叶切除术在70岁以上肺癌患者的应用[J].中华全科医学, 2015, 13(3):381-383.
[18]李新宇,张海云,何荣琦,等.胸腔镜下行肺癌根治术的临床疗效及安全性观察[J].实用医学杂志, 2015, 31(6):962-963.
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