| 摘要: |
| 目的探讨电视胸腔镜肺叶切除术临床疗效,为胸腔镜手术临床推广提供参考。方法回顾性分析上海市肺科医院2004年1月至2009年6月胸腔镜肺叶切除术患者的临床资料,筛选胸腔镜肺叶切除术临床疗效的影响因素。结果入选病例516例,男性282例(54.7%),女性234例(45.3%),年龄35~70岁,平均(55.9±8.1)岁。术后348例(67.4%)病理诊断为恶性病变,168例(32.6%)为良性病变。48例(9.3%)患者出现术后并发症,死亡4例(0.8%)。23例(4.6%)患者术中转为常规开胸手术。手术时间(P=0.025 7,OR=1.015 0,95%CI 1.001 8~1.028 4)是影响术后并发症发生率的唯一独立危险因素。对其中2004年1月至2008年12月266例行胸腔镜肺叶切除术的非小细胞肺癌患者进行生存分析,结果发现术后1、3、5年生存率分别为91.3%、76.5%、54.7%。结论对需手术治疗的肺部疾病患者而言,胸腔镜肺叶切除术是一种安全的治疗手段；胸腔镜肺叶切除术治疗肺癌,同样具有微创优势,但患者选择十分重要。胸腔镜手术应注意控制手术持续时间,否则将增加术后并发症的发生率。 |
| 关键词: 电视胸腔镜手术 肺叶切除术 治疗结果 |
| DOI：10.3724/SP.J.1008.2010.0770 |
| 投稿时间：2009-12-22修订日期：2010-06-01 |
| 基金项目:上海市科学技术委员会登山计划(06DZ19502). |
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| Video-assisted thoracic surgery lobectomy:an analysis of clinical effectiveness of 516 cases |
| ZHANG Yi1,2, JIANG Ge-ning2, ZHU Yu-ming2, XU Zhi-fei1*,xu zhi-fei |
| (1.Department of Cardiothoracic Surgery,Changzheng Hospital,Second Military Medical University, Shanghai 200003, China; 2.Department of Thoracic Surgery, Shanghai Pulmonary Disease Hospital, Tongji University, Shanghai 200433, China) |
| Abstract: |
| ObjectiveTo analyze the clinical effectiveness of video-assisted thoracic surgery (VATS) lobectomy, so as to provide evidence for its popularization in clinical practice.MethodsThe clinical data of patients who received VATS lobectomy from January 2004 to June 2009 were retrospectively analyzed, so as to screen for the factors influencing the effectiveness of VATS.ResultsA total of 516 patients who received VATS lobectomy at Shanghai Pulmonary Disease Hospital were included in the present study; the patients included 282(54.7%) males and 234(45.3%) females, with an age range of 35-70 years old and a mean of (55.9±8.1)years old.Postoperatively 168 patients (32.6%) were diagnosed as benign diseases and 348 (67.4%) as malignant.Post-operation complications were found in 48 (9.3%) patients and 4 (0.8%) patients died after operation.Twenty-three (4.6%) patients were converted to open thoracotomy during operation.Multivariate analysis showed that the operation time (P=0.025 7, OR=1.015 0, 95% CI 1.001 8-1.028 4 ) was the only factor influencing the postoperative complications.Analysis of 266 non-small cell lung cancer patients receiving VATS lobectomy between January 2004 and December 2008 showed that the 1, 3, and 5-year survival rates were 91.3%, 76.5%, and 54.7%, respectively.ConclusionVATS lobectomy is a safe therapeutic method for pulmonary diseases needing surgical treatment.For patients with lung cancer VATS also has the advantage of mini-invasion, but the patients should be carefully selected.The time of VATS procedure should be controlled to avoid postoperative morbidity. |
| Key words: video-assisted thoracic surgery lobectomy outcome |
