CAJ | 학술논문

目的评价临床分期N0的非小细胞肺癌患者胸腔镜手术淋巴结的清扫效果。方法回顾性分析研究2008年1月—2013年6月间201例临床分期N0非小细胞肺癌的资料，比较胸腔镜组与开胸组清扫各站淋巴结数目、切除比率、转移率、术后并发症和五年生存率。结果对于右侧的肺癌，两组3a站淋巴结清扫的数目是相似的（P＞0．05），但是切除比率开胸组却比胸腔镜组高（P＜0．05）。然而，在7和9R站，两个指标均没有统计学差异（P＞0．05）；对于左侧的肺癌，淋巴结数目与切除比率在4L、5L、6L、7L和9L站，两种术式间均没有统计学差异（P＞0．05）。只有在8L站胸腔镜组与开胸组淋巴结清扫数目和切除比率差异有统计学意义（P＜0．05）。淋巴结转移率在胸腔镜组与开胸组之间没有统计学差异（P＞0．05）。两组均有82．1％的患者清扫了至少3站纵膈淋巴结，其中必须有第7站（P＞0．05）。胸腔镜组五年生存率与开胸组相比，差异没有统计学意义（P＞0．05）。结论胸腔镜组清扫淋巴结的效果与开胸组没有统计学差异，胸腔镜手术对于临床分期为N0的非小细胞肺癌患者仍是最佳选择。
목적평개림상분기N0적비소세포폐암환자흉강경수술림파결적청소효과。방법회고성분석연구2008년1월—2013년6월간201례림상분기N0비소세포폐암적자료，비교흉강경조여개흉조청소각참림파결수목、절제비솔、전이솔、술후병발증화오년생존솔。결과대우우측적폐암，량조3a참림파결청소적수목시상사적（P＞0．05），단시절제비솔개흉조각비흉강경조고（P＜0．05）。연이，재7화9R참，량개지표균몰유통계학차이（P＞0．05）；대우좌측적폐암，림파결수목여절제비솔재4L、5L、6L、7L화9L참，량충술식간균몰유통계학차이（P＞0．05）。지유재8L참흉강경조여개흉조림파결청소수목화절제비솔차이유통계학의의（P＜0．05）。림파결전이솔재흉강경조여개흉조지간몰유통계학차이（P＞0．05）。량조균유82．1％적환자청소료지소3참종격림파결，기중필수유제7참（P＞0．05）。흉강경조오년생존솔여개흉조상비，차이몰유통계학의의（P＞0．05）。결론흉강경조청소림파결적효과여개흉조몰유통계학차이，흉강경수술대우림상분기위N0적비소세포폐암환자잉시최가선택。
Objective The aim of this study is to evaluate whether video -assisted thoracoscopic surgi-cal( VATS) lobectomy is as effective as open thoracotomy lobectomy for complete dissection of the mediastinal lymph node(MLN).Methods Patients with clinical stage N0 lung cancer who underwent lobectomy between January 2008 and June 2013were retrospectively evaluated based on the LN station resected and lobectomy proce -dure used,and a resection ratio was calculated .Nodal stage and the proportion of patients ,from whom at least three MLNs and station 7were dissected and compared by lobectomy type .Results Of the 201 patients enrolled in the study,84 and 117 underwent VATS and open thoracotomy lobectomies ,respectively.The mean number of LNs dissected at station 3a was similar in the two groups (1.34 ±2.58 vs.1.52 ±1.78;P>0.05),but the re-section ratio differed(39%sv .63%;P <0.05).However,there were no differences at stations7 and 9R in terms of the number of LNs dissected or resection ratio for the right -sided approaches (P >0.05).There were no differences in the number of LNs dissected or resection ratio between the two groups for stations 4 L,5 L6, L,7 L, and9 L for the left-sided approaches .Only station 8L showed significant differences between the VATS and open thoracotomy groups in the number of LNs dissected (0.12 ±0.44 vs.0.46 ±0.71;P<0.05)and resection ratio (8%vs.36%;P<0.05).There were no differences in the number of LNs dissected or resection ratio between groups for station 7:82.1%of patients in each group had at least three MLNs and station 7 removed(P>0.05). The Kaplan-Meier 5-year survival was also similar between the two groups (log-rank test,P>0.05).Con-clusion VATS lobectomy is as effective as open thoracotomy lobectomy for the dissection of MLNs .Thus,VATS lobotomy resection will continue to be offered as the best choice for patients with clinical stage N0.