Ⅲa-N2期非小细胞肺癌新辅助化疗后胸腔镜手术与开胸手术的比较
发布时间：2019-03-25 17:50
【摘要】：背景和目的:可手术局部晚期(Ⅲa-N2期)非小细胞肺癌新辅助化疗后病变情况较早期肺癌更为复杂,常规需采用开胸手术,该类患者能否施行胸腔镜手术?在技术上和安全性上是否可行?较传统开胸手术是否有优势?目前国内外仍存在广泛争议。本研究通过对临床分期Ⅲa-N2期非小细胞肺癌新辅助化疗后胸腔镜手术与开胸手术的前瞻性随机对照研究,探讨临床分期Ⅲa-N2期非小细胞肺癌新辅助化疗后行胸腔镜肺叶切除术的安全性和可行性,并总结手术经验。方法:本研究选择2012年6月~2016年6月初诊临床分期Ⅲa-N2期已行新辅助化疗并拟行肺叶切除术的非小细胞肺癌患者40例,随机分两组:研究组20例行胸腔镜肺叶切除+系统性淋巴结清扫术;对照组20例行传统开胸肺叶切除+系统性淋巴结清扫术。比较两组手术时间、术中出血量、引流管留置时间、淋巴结清扫数目、术后并发症、术后住院天数、术后VAS疼痛评分。结果:研究组有17例完成胸腔镜肺叶切除术,1例(1/20,5%)行胸腔镜探查术,中转行开胸肺叶切除术2例(2/20,10%);传统开胸组20例均顺利完成肺叶切除术。两组患者无围手术期死亡。两组手术时间:研究组165.47±30.54分,对照组152.53±35.65分。术中出血:研究组187.35±90.93m L,对照组210.29±98.02mL。胸管留置时间:研究组5.42±2.49天,对照组5.35±3.18天。淋巴结清扫数目:研究组9.59±2.32个,对照组9.47±2.03个。术后并发症:研究组2例(11.8%),对照组6例(30.0%)。术后住院天数:研究组7.35±2.03天,对照组10.12±2.32天。两组患者手术时间、术中出血量、引流管留置时间、淋巴结清扫数目差异无统计学意义(P0.05);研究组术后并发症发生率及VAS疼痛评分更低、住院天数更短,差异有统计学意义(P0.05)。结论:临床分期Ⅲa-N2期非小细胞肺癌新辅助化疗后行胸腔镜肺叶切除手术治疗是安全的、可行的,较传统开胸手术具有一定的微创优势。临床分期Ⅲa-N2期非小细胞肺癌患者新辅助化疗后胸腔镜手术,应在化疗后进行精确的疗效评估和手术可行性评估,选择合适的病例施行,化疗疗效较好、无明显肿大融合并侵犯肺门纵膈结构淋巴结者可以选择胸腔镜手术。术前肺内N1淋巴结是否包绕粘连肺内支气管血管的准确评估也是能否选择胸腔镜手术的关键技术点。纵膈淋巴结清扫应采用enbloc切除技术即整块切除技术,应避免淋巴结采样。
[Abstract]:BACKGROUND & OBJECTIVE: The patients with advanced non-small cell lung cancer (NSCLC) with advanced non-small cell lung cancer (NSCLC) with advanced non-small cell lung cancer are more complicated than the early stage of lung cancer. Is technically and safely possible? Is there an advantage over the traditional thoracotomy? There are still a wide range of disputes at home and abroad. The purpose of this study was to investigate the safety and feasibility of a new adjuvant chemotherapy for non-small cell lung cancer in stage 鈪-N2 non-small cell lung cancer after neoadjuvant chemotherapy, and to evaluate the safety and feasibility of thoracoscopic pulmonary lobectomy after neoadjuvant chemotherapy in stage 鈪-N2 non-small cell lung cancer. And summarize the experience of the operation. Methods:40 patients with non-small cell lung cancer who received neoadjuvant chemotherapy in stage 鈪-N2 and non-small cell lung cancer with pulmonary lobectomy were selected from June 2012 to June 2016, and two groups were randomly divided into two groups:20 patients in the study group and 20 patients with systematic lymph node dissection; In the control group,20 cases of conventional thoracotomy + systematic lymph node dissection were performed. The operative time, the intraoperative blood loss, the indwelling time of the drainage tube, the number of lymph node dissection, the postoperative complications, the number of postoperative hospital stay and the VAS pain score were compared. Results: In the study group,17 cases underwent thoracoscopic lobectomy, one case (1/20,5%) underwent thoracoscopic exploration, and 2 cases (2/20,10%) of transthoracic and pulmonary lobectomy were performed in the study group, and 20 cases of the traditional thoracotomy group successfully completed the lobectomy. There were no perioperative deaths in both groups. The operation time of the two groups was 165.47 and 30.54 in the study group, and the control group was 152.53 to 35.65. Intraoperative bleeding: Study group 187.35-90.93 m L, control group 210.29-98.02 mL. The indwelling time of the chest tube: 5.42 to 2.49 days in the study group and 5.35 to 3.18 days in the control group. The number of lymph node dissection: 9.59 to 2.32 in the study group and 9.47 to 2.03 in the control group. Postoperative complications were 2 (11.8%) in the study group and 6 in the control group (30.0%). Post-operative hospitalization days: Study group 7.35-2.03 days, control group 10.12-2.32 days. The operative time of the two groups, the intraoperative blood loss, the time of the indwelling time of the drainage tube and the number of lymph node dissection were not significant (P0.05); the incidence of postoperative complications and the VAS pain score of the study group were lower, and the number of hospitalized days was shorter and the difference was statistically significant (P0.05). Conclusion: The clinical stage 鈪-N2 stage non-small cell lung cancer is safe and feasible after neoadjuvant chemotherapy for non-small cell lung cancer. In the patients with non-small cell lung cancer in stage 鈪-N2 of clinical stage, the patients with non-small cell lung cancer were treated with video-assisted thoracoscopic surgery. Video-assisted thoracoscopic surgery can be selected for patients with non-obvious enlargement and invasion of the mediastinal lymph nodes of the hilar. It is also possible to select the key technology points of video-assisted thoracoscopic surgery. For mediastinal lymph node dissection, the enbloc resection technique, i.e., one-piece resection technique, should be used to avoid lymph node sampling.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2018
【分类号】：R734.2
本文编号：2447185
[Abstract]:BACKGROUND & OBJECTIVE: The patients with advanced non-small cell lung cancer (NSCLC) with advanced non-small cell lung cancer (NSCLC) with advanced non-small cell lung cancer are more complicated than the early stage of lung cancer. Is technically and safely possible? Is there an advantage over the traditional thoracotomy? There are still a wide range of disputes at home and abroad. The purpose of this study was to investigate the safety and feasibility of a new adjuvant chemotherapy for non-small cell lung cancer in stage 鈪-N2 non-small cell lung cancer after neoadjuvant chemotherapy, and to evaluate the safety and feasibility of thoracoscopic pulmonary lobectomy after neoadjuvant chemotherapy in stage 鈪-N2 non-small cell lung cancer. And summarize the experience of the operation. Methods:40 patients with non-small cell lung cancer who received neoadjuvant chemotherapy in stage 鈪-N2 and non-small cell lung cancer with pulmonary lobectomy were selected from June 2012 to June 2016, and two groups were randomly divided into two groups:20 patients in the study group and 20 patients with systematic lymph node dissection; In the control group,20 cases of conventional thoracotomy + systematic lymph node dissection were performed. The operative time, the intraoperative blood loss, the indwelling time of the drainage tube, the number of lymph node dissection, the postoperative complications, the number of postoperative hospital stay and the VAS pain score were compared. Results: In the study group,17 cases underwent thoracoscopic lobectomy, one case (1/20,5%) underwent thoracoscopic exploration, and 2 cases (2/20,10%) of transthoracic and pulmonary lobectomy were performed in the study group, and 20 cases of the traditional thoracotomy group successfully completed the lobectomy. There were no perioperative deaths in both groups. The operation time of the two groups was 165.47 and 30.54 in the study group, and the control group was 152.53 to 35.65. Intraoperative bleeding: Study group 187.35-90.93 m L, control group 210.29-98.02 mL. The indwelling time of the chest tube: 5.42 to 2.49 days in the study group and 5.35 to 3.18 days in the control group. The number of lymph node dissection: 9.59 to 2.32 in the study group and 9.47 to 2.03 in the control group. Postoperative complications were 2 (11.8%) in the study group and 6 in the control group (30.0%). Post-operative hospitalization days: Study group 7.35-2.03 days, control group 10.12-2.32 days. The operative time of the two groups, the intraoperative blood loss, the time of the indwelling time of the drainage tube and the number of lymph node dissection were not significant (P0.05); the incidence of postoperative complications and the VAS pain score of the study group were lower, and the number of hospitalized days was shorter and the difference was statistically significant (P0.05). Conclusion: The clinical stage 鈪-N2 stage non-small cell lung cancer is safe and feasible after neoadjuvant chemotherapy for non-small cell lung cancer. In the patients with non-small cell lung cancer in stage 鈪-N2 of clinical stage, the patients with non-small cell lung cancer were treated with video-assisted thoracoscopic surgery. Video-assisted thoracoscopic surgery can be selected for patients with non-obvious enlargement and invasion of the mediastinal lymph nodes of the hilar. It is also possible to select the key technology points of video-assisted thoracoscopic surgery. For mediastinal lymph node dissection, the enbloc resection technique, i.e., one-piece resection technique, should be used to avoid lymph node sampling.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2018
【分类号】：R734.2
【参考文献】
相关期刊论文 前9条
1 叶永强;罗忠兵;田克强;;单操作孔全胸腔镜肺叶切除术10例体会[J];实用医学杂志;2013年11期
2 刘伦旭;梅建东;蒲强;马林;朱云柯;任福强;车国卫;张小龙;;全胸腔镜支气管袖式成形肺癌切除的初步探讨[J];中国胸心血管外科临床杂志;2011年05期
3 张轶;朱余明;鲍熠;刘鸿程;范江;秦嬴;姜格宁;;全胸腔镜下袖式肺叶切除术治疗支气管肺癌四例[J];中华外科杂志;2012年09期
4 吴一龙;蒋国梁;廖美琳;周清华;陆舜;张力;王俊;王绿化;;非小细胞肺癌ⅢA期N2之处理[J];循证医学;2008年02期
5 邱晓光;俞守义;;62例Ⅲ期非小细胞肺癌新辅助化疗的生存分析[J];广东医学;2007年02期
6 刘树库;许绍发;骆宝剑;刘志东;李福根;韩毅;;1380例手术后的非小细胞肺癌的多因素预后分析[J];中国肺癌杂志;2006年05期
7 张志庸,郭峰,崔玉尚,李单青,李力,徐晓辉,戈烽,郭惠琴,李泽坚;北京协和医院外科治疗肺癌生存率变化分析[J];中国肺癌杂志;2005年02期
8 周清华,刘伦旭,李潞,车国卫,杨俊杰,赵雍凡,陈军,王允,秦建军,侯梅,宫友陵,卢武胜,李志平;术前新辅助化疗加外科手术治疗Ⅲ期非小细胞肺癌的随机对照临床试验[J];中国肺癌杂志;2001年04期
9 吴一龙,黄植蕃,戎铁华,杨名添;基于97分期的非小细胞肺癌术后分期和生存研究[J];中华肿瘤杂志;1999年05期
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