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目的:与开胸肺叶切除对比,探讨全胸腔镜(video-assisted thoracoscopic surgery,VATS)下肺叶切除治疗术前分期淋巴结阴性、术后病理纵隔淋巴结阳性(preoperative staging of lymph node negative and postoperative pathologi-cal mediastinal lymph node positive,cN0-pN2)的局部进展期非小细胞肺癌的安全性、彻底性和有效性。方法:回顾性分析2000年7月至2009年12月接受开胸或VATS肺叶切除的患者共616例,其中术前分期淋巴结阴性非小细胞肺癌患者共386例,在这386例中术后病理发现纵隔淋巴结阳性76例,按照手术方式分为VATS组29例,开胸组47例。对比两组术前、术中情况及术后生存、复发情况。结果:两组在年龄、性别分布、肺功能、术前合并症、术前临床分期相似;手术时间和出血量VATS组略低于开胸组。VATS与开胸组相比,纵隔淋巴结清扫组数为(3.3±1.1)与(3.3±1.3)组(P=0.959),清扫个数为(12.7±8.9)与(10.5±7.2)个(P=0.260),阳性淋巴结/清扫淋巴结分别为28.7%和32.5%(P=0.592),术后单组N2淋巴结阳性比例分别为55.2%与66.0%(P=0.189);术后1、3年无瘤存活率分别为82.6%与69.2%(P=0.088)及49.3%与51.3%(P=0.996);1、3年总体存活率分别为84.9%与71.2%(P=0.149)及64.0%与42.7%(P=0.121);肿瘤复发方式相似,均以远处转移为主,局部复发仅占少数。结论:VATS肺叶切除治疗cN0-pN2非小细胞肺癌与开胸手术同样安全和彻底,近期效果相似。
PURPOSE: To investigate the effect of lobectomy on preoperative staging of lymph node negative and postoperative pathologi-cal (CAL) after video-assisted thoracoscopic surgery (VATS) mediastinal lymph node positive, cN0-pN2) in locally advanced non-small cell lung cancer. Methods: A total of 616 patients undergoing thoracotomy or VATS lobectomy from July 2000 to December 2009 were retrospectively analyzed, including 386 patients with preoperative lymph node-negative NSCLC. Of these 386 patients, postoperative pathology Found in 76 cases of mediastinal lymph nodes, according to the surgical approach divided into VATS group 29 cases, open chest group 47 cases. The two groups were compared before and after surgery, postoperative survival and recurrence. Results: The age, gender distribution, pulmonary function, preoperative complications and clinical stage were similar in both groups. The operation time and the amount of bleeding in VATS group were slightly lower than those in the thoracotomy group. Compared with thoracotomy group, the number of mediastinal lymph node dissection in VATS group was (3.3 ± 1.1) vs (3.3 ± 1.3) (P = 0.959), and the number of dissection was (12.7 ± 8.9) and (10.5 ± 7.2) = 0.260), positive lymph node / lymph node dissection was 28.7% and 32.5% respectively (P = 0.592), postoperative lymph node positive rate of single group was 55.2% and 66.0% (P = 0.189) The overall survival rates at 1 and 3 years were 84.9% and 71.2% (P = 0.149) and 64.0% with the overall survival rates of 82.6% and 69.2% (P = 0.088) and 49.3% and 51.3% 42.7% (P = 0.121). The tumor recurrences were similar with distant metastasis and local recurrence only a minority. CONCLUSIONS: VATS lobectomy for cN0-pN2 non-small cell lung cancer is as safe and thorough as thoracotomy and has recently achieved similar results.