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目的分析全胸腔镜下肺叶切除与开胸肺叶切除治疗隐匿性N2(c N0-p N2)期非小细胞肺癌患者的近期效果与远期预后差异,以及对于已选择胸腔镜手术(VATS)的隐匿性N2患者是否需要中转开胸。方法初步纳入1 754例2009年1月至2014年12月在本中心同一医疗组处接受肺叶切除手术的1 754例c N0患者,筛选出262例c N0-p N2的患者,按照手术方式分为VATS组107例和开放组155例。VATS组男50例、女57例,年龄36~75(61.5±10.7)岁;开放组男104例、女51例,年龄31~73(59.0±8.7)岁。对比两组术前、术中以及术后近期效果及远期生存情况。结果两组患者年龄、肺功能、术前基础疾病差异无统计学意义。VATS组手术时间长于开放组(P=0.044),但术后住院时间开放组明显长于VATS组(P=0.008)。开放组肿瘤最大直径远大于腔镜组肿瘤最大直径(P<0.05);两组清扫纵隔淋巴结组数差异无统计学意义(P=0.067),纵隔淋巴结阳性率VATS组与开放组的差异也无统计学意义(P=0.055)。VATS组术后1年总生存率(OS)为91.6%,3年OS为58.3%;开放组术后1年OS为81.9%,3年OS为47.3%。结论胸腔镜治疗隐匿性N2患者与开胸手术可达到同样的切除率,且VATS近期效果更佳。但隐匿性N2患者的预后与肿瘤大小可能更相关,而与手术方式无关,但仍需进一步前瞻性研究论证。
Objective To analyze the short-term and long-term prognosis of patients undergoing thoracoscopic lobectomy and thoracotomy for the treatment of occult N2 (cN0-p N2) non-small cell lung cancer (NSCLC), and to evaluate the effect of thoracoscopic surgery (VATS) Occult N2 patients need to transfer to open chest. Methods A total of 1 754 cN0 patients undergoing lobectomy in the same medical team from January 2009 to December 2014 were enrolled in this study. A total of 262 patients with cN0-p N2 were screened out according to the operation method There were 107 cases in the VATS group and 155 cases in the open group. In the VATS group, there were 50 males and 57 females, ranging in age from 36 to 75 (61.5 ± 10.7) years. In the open group, 104 males and 51 females, aged 31-73 years (59.0 ± 8.7 years). Compare the two groups of preoperative, intraoperative and postoperative short-term effects and long-term survival. Results There was no significant difference in age, pulmonary function and preoperative basic disease between the two groups. The VATS group had a longer operative time than the open group (P = 0.044), but the postoperative hospital stay was significantly longer in the open group than in the VATS group (P = 0.008). The maximum diameter of the tumor in the open group was much larger than the maximum diameter of the tumor in the laparoscopic group (P <0.05). There was no significant difference in the number of mediastinal lymph nodes between the two groups (P = 0.067), nor was the difference between the VATS group and the open group Statistical significance (P = 0.055). The 1-year overall survival (OS) was 91.6% in the VATS group and 58.3% in the 3-year OS group. One-year OS was 81.9% in the open group and 47.3% in the 3-year OS group. Conclusion Thoracoscopic treatment of occult N2 patients and thoracotomy can achieve the same resection rate, and VATS better results in the near future. However, the prognosis of occult N2 patients may be more related to the size of the tumor, but not to the surgical method, but further prospective research is still needed.