电视胸腔镜微刨治疗老年非小细胞肺癌的临床研究及安全性评价

摘要

Objective To study the clinical efficacy and the safety of video-assisted thoracoscopic surgery (VATS) in the treatment of elderly patients with non-small cell lung cancer (NSCLC). Methods 90 cases of elderly patients with NSCLC were divided into three groups, which were the VATS group (n = 24), the video-assisted mini-thoracoscope group (VAMT, n = 26), and the thoracotomy group (SPT, n = 40). The intraoperative and postoperative conditions, the recurrence and metastasis conditions after one year of the three groups were observed and compared. Results The operation time, intraoperative blood loss, incision length, drainage time, postoperative analgesia time, dosage of painkiller, hospitalization time of the VATS and VAMT groups were all less or shorter than those of the SPT group (P < 0.01). The operation time of the VATS group was longer than that of the VAMT group, but the intraoperative blood loss, incision length, hospitalization time of the VATS group were less or shorter than the VAMT group (P < 0.05 or P < 0.01), and the hospitalization expenses of the VATS group was more than the VAMT group (P < 0.01). The postoperative complications rate of the SPT group was higher than the VATS and VAMT group. Conclusion For the NSCLC patients aged more than 60, grasping the adaption of operation strictly, careful preoperative evaluation and sufficient preparation are necessary for definite effect of thoracoscope treatment. But VATS or VAMT should be chosen according to the concrete conditions of patients (instance economic status, patients' will and so on) and the proficiency the operator.%目的 探讨电视胸腔镜手术治疗老年非小细胞肺癌(NSCLC)的临床效果及安全性.方法 将90例老年NSCLC患者按手术方式分为三组,全胸腔镜手术(VATS)组24例,胸腔镜辅助小切口开胸术(VAMT)组26例,常规开胸手术(SPT)组40例.观察三组的术中、术后情况及随访1年的复发和转移情况.结果 VATS组和VAMT组的手术时间、术中出血量、切口长度、引流管留置时间、术后止痛时间、止痛药用量、住院时间均明显少于或短于SPT组(P<0.01);而VATS组手术时间长于VAMT组,但术中出血量、切口长度、住院时间均明显少于VAMT组(P<0.05或P<0.01),VATS组的住院费用明显多于VAMT组(P<0.01);SPT组并发症发生率高于VATS组和VAMT组(P<0.05).结论 对于60岁以上的老年NSCLC患者,在严格掌握手术适应证及做好仔细的术前评估和充分的术前准备的前提下,胸腔镜治疗的疗效肯定.选择完全胸腔镜手术或胸腔镜辅助小切口手术应根据患者具体情况(如经济情况、患者意愿等)和术者对胸腔镜的熟练程度来决定.