CAJ | 학술논문

目的观察单向式胸腔镜肺切除术手术治疗Ⅰ期肺癌的远期效果.方法 2006年5月至2013年12月共有3 743例肺癌患者于四川大学华西医院胸外科接受手术治疗,纳入其中接受单向式胸腔镜肺叶或肺段切除术治疗的783例术后病理证实为Ⅰ期肺癌的患者.男性388例,女性395例;年龄25～ 86岁,平均(59±10)岁.手术方法包括肺叶切除740例,肺段切除43例,中转开胸20例.回顾性分析患者临床病理及随访资料,采用Kaplan-Meier法及Cox比例风险回归模型分析患者远期生存情况及可能的预后因素.结果全组患者的手术时间70～ 460 min,平均(145±54) min;术中出血量5 ～1 200 ml,中位数为50(70) ml.术后并发症发生率和90 d病死率分别为13.3％和1.0％.730例患者获得随访,失访率为5.9％,随访时间5 ～ 92个月,平均随访时间(37±18)个月,术后5年总体生存率、无病生存率和肿瘤特异性生存率分别为83.8％、74.4％和86.6％.多因素分析结果显示,年龄≥60岁(OR=1.786,95％ CI:1.081 ～2.948,P=0.023)、非腺癌(OR=1.647,95％ CI:1.204～2.253,P=0.002)、高T分期(OR=2.709,95％ CI:1.031 ～7.121,P=0.043)是患者总体生存率的独立不良风险因素;高T分期(OR=5.118,95％ CI:2.330～11.240,P=0.000)、高病理分期(OR =0.369,95％ CI:0.137～0.991,P=0.048)是无病生存率的独立不良风险因素;非腺癌(OR=1.717,95％ CI:1.224～2.409,P=0.002)、高T分期(OR=5.029,95％ CI:1.432 ～ 17.659,P=0.012)是肿瘤特异性生存率的独立不良风险因素.结论单向式胸腔镜肺癌切除术治疗Ⅰ期肺癌安全、可行,并可获得良好远期预后.
목적 관찰단향식흉강경폐절제술수술치료Ⅰ기폐암적원기효과.방법 2006년5월지2013년12월공유3 743례폐암환자우사천대학화서의원흉외과접수수술치료,납입기중접수단향식흉강경폐협혹폐단절제술치료적783례술후병리증실위Ⅰ기폐암적환자.남성388례,녀성395례;년령25～ 86세,평균(59±10)세.수술방법포괄폐협절제740례,폐단절제43례,중전개흉20례.회고성분석환자림상병리급수방자료,채용Kaplan-Meier법급Cox비례풍험회귀모형분석환자원기생존정황급가능적예후인소.결과 전조환자적수술시간70～ 460 min,평균(145±54) min;술중출혈량5 ～1 200 ml,중위수위50(70) ml.술후병발증발생솔화90 d병사솔분별위13.3％화1.0％.730례환자획득수방,실방솔위5.9％,수방시간5 ～ 92개월,평균수방시간(37±18)개월,술후5년총체생존솔、무병생존솔화종류특이성생존솔분별위83.8％、74.4％화86.6％.다인소분석결과현시,년령≥60세(OR=1.786,95％ CI:1.081 ～2.948,P=0.023)、비선암(OR=1.647,95％ CI:1.204～2.253,P=0.002)、고T분기(OR=2.709,95％ CI:1.031 ～7.121,P=0.043)시환자총체생존솔적독립불량풍험인소;고T분기(OR=5.118,95％ CI:2.330～11.240,P=0.000)、고병리분기(OR =0.369,95％ CI:0.137～0.991,P=0.048)시무병생존솔적독립불량풍험인소;비선암(OR=1.717,95％ CI:1.224～2.409,P=0.002)、고T분기(OR=5.029,95％ CI:1.432 ～ 17.659,P=0.012)시종류특이성생존솔적독립불량풍험인소.결론 단향식흉강경폐암절제술치료Ⅰ기폐암안전、가행,병가획득량호원기예후.
Objective To observe the outcome of stage Ⅰ lung cancer treated by single-direction video-assisted thoracoscopic surgery (SD-VATS) major lung resection.Methods Between May 2006 and December 2013,a total of 3 743 patients with lung cancer underwent surgical treatment in Department of Thoracic Surgery,West China Hospital.The clinical date of 783 patients with stage Ⅰ lung cancer treated by SD-VATS lobectomy/segmentectomy was analyzed retrospectively.There were 388 males and 395 females with a mean age of (59 ± 10) years (range 25 to 86 years).There were 740 cases of lobectomy and 43 cases of segmentectomy.Twenty patients underwent conversion to open thoracotomy.The methods of Kaplan-Meier survival analysis and Cox proportional hazard regression model were used to investigate the long term outcome and prognostic factors.Results The mean operating time was (145 ± 54) minutes (range 70 to 460 minutes).The median intraoperative blood loss was 50 (70) ml (range 5 to 1 200 ml).The postoperative morbidity and 90-day mortality were 13.3％ and 1.0％,respectively.5.9％ patients were lost to follow-up.Finally 730 patients were enrolled into prognostic analysis with a mean follow-up time of (37 ± 18) months (range 5 to 92 months).The 5-year overall survival (OS),disease free survival (DFS),and cancer specific survival (CSS) were 83.8％,74.4％,and 86.6％,respectively.The 5-year OS of Ⅰ A and Ⅰ B were 90.7％ and 79.8％ respectively.Univariate and multivariate analysis indicated that age ≥ 60 years (OR =1.786,95％ CI:1.081 to 2.948,P =0.023),non-adenocarcinoma (OR =1.647,95％ CI:1.204 to 2.253,P =0.002),and higher T status (OR =2.709,95％ CI:1.031 to 7.121,P =0.043) were independently associated with poor OS;higher T status (OR =5.118,95％ CI:2.330 to 11.240,P =0.000) and higher pathological stage status (OR =0.369,95％ CI:0.137 to 0.991,P =0.048) were independently associated with poor DFS;non-adenocarcinoma (OR =1.717,95％ CI:1.224 to2.409,P=0.002) and higher T status (OR =5.029,95％ CI:1.432 to 17.659,P =0.012) were independently associated with poor CSS.Conclusion SD-VATS lung cancer resection is a safe and feasible method for the treatment of stage Ⅰ lung cancer resulting good outcomes.