全胸腔镜与传统开胸下非小细胞肺癌纵隔淋巴结清扫的倾向得分匹配研究

发布时间：2018-10-08 12:05

【摘要】：目的:回顾性分析全胸腔镜下非小细胞肺癌纵隔淋巴结清扫的围手术期资料,以同期传统开胸手术病例作对照,对比研究两种手术方式下纵隔淋巴结清扫的差异性以及清扫后并发症的发生率情况。方法:选取2010年1月至2015年7月湖州市中心医院胸心外科非小细胞肺癌患者经手术治疗者的围手术期资料,其中497例行肺叶切除+系统性纵隔淋巴结清扫者作为研究对象,按照手术方式不同分为全胸腔镜手术(观察组)242例和传统开胸手术(对照组)255例。采用倾向得分匹配法对两组基线资料进行1:1匹配,比较配比后两组在围手术期参数、病理类型、纵隔淋巴结清扫数情况及cN0-pN2比例等方面的差异。结果:本研究共纳入497例行肺叶切除+系统性纵隔淋巴结清扫的非小细胞肺癌病例,其中观察组242例,对照组255例,采用倾向得分匹配法完成匹配376例,每组188例,配比后两组基线资料比较差异无显著性,P0.05;观察组与对照组比较:平均纵隔淋巴结清扫组数为4.14±0.57组比3.97±0.62组(F=7.28,P0.01);平均纵隔淋巴结清扫枚数为16.63±4.84枚比17.32±3.63枚(F=2.46,P=0.12);左侧肺癌第7组淋巴结清扫枚数为7.25±2.13比8.78±2.91,F=10.98,P0.01),其余部位清扫枚数差异无显著性(P0.05);两组总转移率为3.84%比4.33%(x2=0.98,P=0.32),总转移度为8.23%比7.36%(x2=0.39,P=0.52);术后病理[腺癌(67.55%比68.62%,X2=0.05,P=0.82),鳞癌(22.34%比23.94%比,X2=0.13,P=0.71),其他类型(10.11%比7.44%,X2=0.83,P=0.36)];手术时间[(153.24±21.91)min比(162.23±22.75)min,F=15.23,P＜0.01];术中失血[(158.51±95.39)ml比(166.49±104.03)ml,F=0.60,P=0.44];手术副损伤[气管损伤(1.59%比2.13%,X2=0.15,P=0.70),食管损伤(0.53%比 1.06,X2=0.34,P=0.56),喉返神经损伤(2.66%比 1.59%,X2=0.51,P=0.47),胸导管损伤,1.06%比0.53%,X2=0.34,P=0.56),大血管损伤(3.19%比2.13%,X2=0.41,P=0.52);术后24小时引流量[(252.85±129.81)ml比(258.19±105.34)ml,F=0.11,P=0.74];术后并发症[声音嘶哑(4.26%比3.72%,X2=0.07,P=0.79),心律失常(2.66%比3.19%,X2=0.09,P=0.76),乳糜胸(1.59%比2.13%,X2=0.34,P=0.56)];术后住院天数[(9.02±3.61)d比(10.18±3.97)d,F=8.85,P0.01]。结论:全胸腔镜下非小细胞肺癌纵隔淋巴结清扫手术在术后恢复、并发症及住院天数方面存在优势,手术风险未明显增加,总体纵隔淋巴结清扫有效性与传统开胸手术相当,但左侧肺癌行第7组淋巴结清扫能力差于传统开胸手术。
[Abstract]:Objective: to analyze retrospectively the perioperative data of mediastinal lymph node dissection in non-small cell lung cancer (NSCLC) under total thoracoscopy, and to compare the data of the patients with traditional thoracotomy in the same period. To compare the difference of mediastinal lymph node dissection and the incidence of complications after dissection. Methods: the perioperative data of patients with non-small cell lung cancer (NSCLC) in thoracic and cardiac surgery of Huzhou Central Hospital from January 2010 to July 2015 were selected. 497 patients underwent systemic mediastinal lymph node dissection after lobectomy. There were 242 cases of total thoracoscopic surgery (observation group) and 255 cases of traditional thoracotomy (control group). The baseline data of the two groups were matched by inclination score matching method at 1:1. The differences of perioperative parameters pathological types mediastinal lymph node dissection and cN0-pN2 ratio between the two groups were compared after matching. Results: 497 cases of non-small cell lung cancer with systemic mediastinal lymph node dissection were included in this study, including 242 cases in the observation group and 255 cases in the control group. 376 cases (188 cases in each group) were matched by tendency score matching method. After matching, there was no significant difference in baseline data between the two groups (P 0.05); the average number of mediastinal lymph node dissection was 4.14 卤0.57 vs 3.97 卤0.62 in the observation group and 3.97 卤0.62 in the control group, 16.63 卤4.84 in the average mediastinal lymph node dissection vs 17.32 卤3.63 in the control group, and 7 in the left lung cancer. 缁勬穻宸寸粨娓呮壂鏋氭暟涓，

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