摘要目的 比较电视辅助胸外科手术(VATS)与常规开胸手术治疗非小细胞肺癌的近期效果.方法 回顾性分析中国医学科学院肿瘤医院胸外科VATS治疗的737例非小细胞肺癌连续病例的资料,以同期常规开胸行肺叶切除术或楔形切除术的630例非小细胞肺癌患者为对照组,比较两组的近期手术效果.采用单因素和Logistic多因素回归分析,研究肺叶切除术术后并发症发生的危险因素.结果 VATS组506例肺叶切除术患者中,发生术后并发症13例(2.6％),围手术期死亡1例(0.2％).常规开胸组521例肺叶切除术患者中,发生术后并发症21例(4.0％),围手术期死亡1例(0.2％).两组间术后并发症的发生率和围手术期死亡率差异无统计学意义(均P ＞0.05).VATS组190例肺楔形切除术患者中,发生术后并发症3例(1.6％).常规开胸组109例肺叶切除术患者中,发生术后并发症4例(3.7％).两组间术后并发症的发生率差异无统计学意义(P =0.262),且均无围手术期死亡.多因素分析结果显示,患者的年龄(OR=1.047,95％ CI为1.004 ～1.091)、吸烟史(OR=6.374,95％CI为2.588～ 15.695)和手术时间(OR=1.418,95％ CI为1.075 ～1.871)是术后并发症发生的独立危险因素.结论 对于须行肺叶切除术或肺楔形切除术的非小细胞肺癌患者,VATS近期效果与常规开胸术相当.

abstractsObjective To compare the short-term outcomes of surgical treatment for non-small cell lung cancer (NSCLC) by video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT).Methods Data of 737 consecutive NSCLC patients who underwent surgical treatment for non-small cell lung cancer by video-assisted thoracoscopic surgery and 630 patients who underwent pulmonary resection via open thoracotomy (as controls) in Cancer Institute & Hospital,Chinese Academy of Medical Sciences between January 2009 and August 2011 were retrospectively reviewed.The risk factors after lobectomy were also analyzed.Results In the 506 NSCLC patients who received VATS lobectomy,postoperative complications occurred in 13 patients (2.6％) and one patient died of acute respiratory distress syndrome (0.2％).In the 521 patients who received open thoracotomy (OT) lobectomy,postoperative complications occurred in 21 patients (4.0％) and one patient died of pulmonary infection (0.2％).There was no significant difference in the morbidity rate ( P ＞ 0.05 ) and mortality rate ( P ＞ 0.05 ) between the VATS group and OT group.In the 190 patients who received VATS wedge resections,postoperative complications occurred in 3 patients (1.6％ ). One hundred and nine patients received OT wedge resections. Postoperative complications occurred in 4 patients ( 3.7％ ).There were no significant differences for morbidity rate ( P =0.262 ) between these two groups,and there was no perioperative death in these two groups. Univariate and multivariate analyses demonstrated that age (OR =1.047,95％ CI:1.004-1.091 ),history of smoking (OR =6.374,95％ CI:2.588-15.695) and operation time ( OR =1.418,95％ CI:1.075-1.871 ) were independent risk factors of postoperative complications.Conclusions To compare with the NSCLC patients who should undergo lobectomy or wedge resection via open thoracotomy,a similar short-term outcome can be achieved via VATS approach.