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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (11): 38-43.doi: 10.6040/j.issn.1671-7554.0.2022.0606

• 胸外科肺癌、食管癌微创诊治和加速康复专题 • 上一篇    下一篇

34例胸腔镜下肺楔形切除与21例肺段切除对位于肺段P区的ⅠA1期非小细胞肺癌治疗比较

刘会宁*(),彭军,任迎春,杨光,王文豪,刘金锋,田勍   

  1. 河北医科大学第一医院胸外科, 河北 石家庄 050000
  • 收稿日期:2022-05-18 出版日期:2022-11-01 发布日期:2022-11-04
  • 通讯作者: 刘会宁 E-mail:liuhuining1972@163.com
  • 作者简介:刘会宁，河北医科大学第一医院胸外科主任，主任医师、教授、医学博士、博士后；河北医科大学硕士研究生导师，伦敦帝国理工大学及Hammer Smith胸心外科医院访问学者，河北省重点发展学科带头人，河北省重点专科后备带头人，担任《中华肿瘤防治杂志》编委。从事胸外科专业20余年，擅长胸部肿瘤的诊治，尤其针对肺小结节、肺部肿瘤的诊治有独到之处。获得河北省自然基金项目等省级课题10余项，专利2项，编写专著10部，发表论文20余篇, 其中SCI论文5篇。以第一主研人主持课题有“NF-M在胸腺瘤组织中的表达与重症肌无力发生的相关研究”“家族性食管癌差异基因分析”“食管癌相关蛋白质的筛选和分析研究”“肿瘤相关钙信号转导蛋白1基因(TACSTD1)在食管鳞状细胞癌中表达的调控研究”“胸腔镜专用吻合器械的研发及实验”“miR-181b在小细胞肺癌耐药相关机制中的作用研究”“通过miR-181b调节在小细胞肺癌患者耐药发生的实验研究”及“miR-181b/ACE途径调节在小细胞肺癌的机制研究”。社会任职：河北预防医学会肺结节及气管疾病专委会主任委员, 中国研究型医院学会胸外科分会河北委员, 北京健康促进会呼吸及介入诊疗联盟常委, 河北省免疫学会烧创伤分会常委, 河北省中西医结合学会胸外科分会常委, 中华医学会河北省胸心外科学会委员
  • 基金资助:
    2022年政府资助优秀人才项目(LS202210)

Comparison of 34 cases of thoracoscopic wedge resection and 21 cases of segmental resection for stage ⅠA1 non-small cell lung cancer in area P

Huining LIU*(),Jun PENG,Yingchun REN,Guang YANG,Wenhao WANG,Jinfeng LIU,Qing TIAN   

  1. Department of Thoracic Surgery, the First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China
  • Received:2022-05-18 Online:2022-11-01 Published:2022-11-04
  • Contact: Huining LIU E-mail:liuhuining1972@163.com

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摘要：

目的: 探讨根据影像资料划分病灶所在的肺段位置，来选择位于P区的ⅠA1期非小细胞肺癌的胸腔镜微创手术方法，比较根据新的肺段分区方法采取手术方式的情况及预后。方法: 回顾性分析接受胸腔镜下肺楔形切除术和肺段切除术的患者55例，以手术方式不同分为楔形切除术组(A组，n=34)和肺段切除术组(B组，n=21)。结果: 位于P区的ⅠA1期非小细胞肺癌，A组的手术时间为(18.50±5.55)min，B组为(61.23±9.83)min；术后住院时间两组分别为(3.14±0.95)d和(4.95±1.39)d；术中出血量两组分别为(12.67±6.54)mL和(103.71±16.99)mL；住院经济花费两组分别为(3.59±0.50)万元和(6.19±1.02)万元；术后肺漏气两组分别为2例(5.88%)和6例(28.57%)，上述指标两组间差异均有统计学意义(P < 0.05)。单因素Logistic回归分析显示，手术时间、术后住院时间及肺漏气与不同的手术方式之间有统计学意义的关联(P＜0.05)。多因素二分类Logistic回归分析显示，与B组相比，A组能缩短手术时间(OR=2.58，95%CI：1.71~3.90，P < 0.001)、术后住院时间(OR=2.91，95%CI：1.01~8.84，P=0.04)和减少肺漏气(OR=7.12，95%CI：1.13~37.21，P=0.04)。结论: ⅠA1期非小细胞肺癌患者，病灶位于P区采取的胸腔镜下肺楔形切除术比采取肺段切除术具有明显的优势。

关键词: 非小细胞肺癌, 新肺段分区, P区, 肺楔形切除, 肺段切除

Abstract:

Objective: To investigate the selection of minimally invasive thoracoscopic surgery for stage ⅠA1 non-small cell lung cancer (NSCLC) in area P by dividing the lung segment location of the lesion according to the imaging data, and to compare the prognosis of the two methods. Methods: A retrospective analysis was performed on 55 patients who underwent thoracoscopic wedge resection and segmentectomy, and the patients were divided into wedge resection group (group A, n=34) and segmentectomy group (group B, n=21). Results: In groups A and B, the operation time, postoperative hospital stay, intraoperative bleeding, hospitalization costs, and incidence of postoperative pulmonary air leakage were (18.50±5.55) vs. (61.23±9.83), (3.14±0.95) d vs. (4.95±1.39) d, (12.67±6.54) mL vs. (103.71±16.99) mL, (35, 900±5, 000) yuan vs. (61, 900±10, 200) yuan, 5.88% (2 cases) vs. 28.57% (6 cases), respectively, with statistically significant differences (all P < 0.05). Univariate Logistic regression analysis showed a significant correlation between operation time, postoperative hospital stay, incidence of lung leakage and different operation methods (P < 0.05). Multivariate binary Logistic regression analysis showed that compared with group B, group A had shortened operation time (OR=2.58, 95%CI: 1.71-3.90, P < 0.001), shorter postoperative hospital stay (OR=2.91, 95%CI: 1.01-8.84, P=0.04) and reduced incidence of lung leakage (OR=7.12, 95%CI: 1.13-37.21, P=0.04). Conclusion: For patients with stage ⅠA1 NSCLC, thoracoscopic wedge resection of lung with lesion located in area P has a significant advantage over segmental resection.

Key words: Non-small cell lung cancer, New lung segmental partition, P area, Wedge resection, Segmental resection

中图分类号: 

  • R734.2

表1

两组P区ⅠA1期非小细胞肺癌患者的一般临床特征"

特征 A组(n=34) B组(n=21) t/χ2 P
性别[ n(%)] 0.01 0.92
  男 19(55.88) 12(57.14)
  女 15(44.12) 9(42.86)
年龄(岁) 56.41±11.55 57.05±11.78 0.21 0.83
病例类型[ n(%)] 0.06 0.96
  原位癌 12(35.29) 8(38.09)
  微浸润癌 20(58.82) 12(57.14)
  其他 2(5.89) 1(4.77)
P区肿瘤位置[ n(%)] 0.75 0.94
  右肺上叶 6(17.65) 4(19.05)
  右肺中叶 5(14.71) 2(9.52)
  右肺下叶 8(23.52) 5(23.81)
  左肺上叶 7(20.60) 6(28.57)
  左肺下叶 8(23.52) 4(19.05)

表2

两组P区ⅠA1期非小细胞肺癌患者手术情况比较"

特征 A组(n=34) B组(n=21) t P
手术时间(min) 18.50±5.55 61.23±9.83 20.63 ＜0.001
术后住院时间(d) 3.14±0.95 4.95±1.99 5.69 ＜0.001
术中出血量(mL) 12.67±6.54 103.71±16.99 28.06 ＜0.001
住院费用(万元) 3.59±0.50 6.19±1.02 12.63 ＜0.001

表3

两组P区ⅠA1期非小细胞肺癌患者切缘复发及术后并发症比较[n(%)]"

特征 A组(n=34) B组(n=21) P
肺不张 3(8.82) 5(23.81) 0.23
肺漏气 2(5.88) 6(28.57) 0.04
发热 4(11.76) 5(23.81) 0.28
心律失常 2(5.88) 4(19.05) 0.18
切缘复发 0(0.00) 0(0.00) —

表4

两种手术方式相关因素的Logistic回归分析"

影响因素 单因素分析 多因素分析
OR(95%CI) P OR(95%CI) P
性别 1.05(0.35~3.15) 0.93 — —
年龄 0.95(0.32~2.85) 0.84 — —
P区肿瘤位置 0.87(0.29~2.59) 0.80 — —
手术时间 2.55(1.67~3.91) < 0.001 2.58(1.71~3.90) < 0.001
术后住院时间 4.35(1.99~9.47) < 0.001 2.91(1.01~8.84) 0.04
术中出血量 1.18(0.39~3.54) 0.76 — —
住院费用 3.72(0.54~6.09) 0.07 — —
肺不张 0.31(0.06~1.46) 0.14 0.28(0.06~1.46) 0.13
肺漏气 6.40(1.15~35.52) 0.03 7.12(1.13~37.21) 0.04
发热 0.43(0.10~1.82) 0.25 0.40(0.08~1.86) 0.24
心律失常 0.27(0.04~1.60) 0.15 0.25(0.04~1.60) 0.14
1 Siegel RL , Miller KD , Jemal A . Cancer statistics, 2017[J]. CA Cancer J Clin, 2017, 67 (1): 7- 30.
doi: 10.3322/caac.21387
2 Gelatti ACZ , Drilon A , Santini FC . Optimizing the sequencing of tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC)[J]. Lung Cancer, 2019, 137, 113- 122.
doi: 10.1016/j.lungcan.2019.09.017
3 Ganti AK , Klein AB , Cotarla I , et al. Update of incidence, prevalence, survival, and initial treatment in patients with non-small cell lung cancer in the US[J]. JAMA Oncol, 2021, 7 (12): 1824- 1832.
doi: 10.1001/jamaoncol.2021.4932
4 Altorki NK , Kamel MK , Narula N , et al. Anatomical segmentectomy and wedge resections are associated with comparable outcomes for patients with small cT1N0 non-small cell lung cancer[J]. J Thorac Oncol, 2016, 11 (11): 1984- 1992.
doi: 10.1016/j.jtho.2016.06.031
5 Bachman KC , Worrell SG , Linden PA , et al. Wedge resection offers similar survival to segmentectomy for typical carcinoid tumors[J]. Semin Thorac Cardiovasc Surg, 2022, 34 (1): 293- 298.
doi: 10.1053/j.semtcvs.2021.03.005
6 Tsutani Y , Handa Y , Shimada Y , et al. Comparison of cancer control between segmentectomy and wedge resection in patients with clinical stage ⅠA non-small cell lung cancer[J]. J Thorac Cardiovasc Surg, 2021, 162 (4): 1244- 1252.
doi: 10.1016/j.jtcvs.2020.10.024
7 Wu CF , Fu JY , Li YS , et al. Surgical result in non small cell lung cancer patients presenting with ground glass opacity predominant lesion less than 2 cm: anatomic versus wedge resection[J]. Biomed J, 2021, 44 (6 Suppl 2): S235- S241.
8 Gu Z , Wang H , Mao T , et al. Pulmonary function changes after different extent of pulmonary resection under video-assisted thoracic surgery[J]. J Thorac Dis, 2018, 10 (4): 2331- 2337.
doi: 10.21037/jtd.2018.03.163
9 Zhou Y , Yu T , Zhang Y , et al. Comparison of surgical outcomes and prognosis between wedge resection and simple segmentectomy for GGO diameter between 2 cm and 3 cm in non-small cell lung cancer: a multicenter and propensity score matching analysis[J]. BMC Cancer, 2022, 22 (1): 71.
doi: 10.1186/s12885-021-09129-0
10 陈醒狮, 金润森, 李鹤成. 肺段切除术中段间平面处理方式的研究进展[J]. 中国微创外科杂志, 2019, 19 (2): 190- 192.
doi: 10.3969/j.issn.1009-6604.2019.02.025
11 Gao YG , Wang T , Shi YB , et al. Preoperative computed tomography-guided coil localization of sub-centimeter lung nodules[J]. Kardiochir Torakochirurgia Pol, 2021, 18 (3): 127- 130.
12 于雷, 赵庆涛, 王志康, 等. 术中冰冻病理对肺结节胸腔镜手术切除范围的指导意义[J]. 中国微创外科杂志, 2020, 20 (3): 230- 233.
YU Lei , ZHAO Qingtao , WANG Zhikang , et al. The significance of intraoperative frozen pathology for video-assisted thoracoscopic resection range for lung nodules[J]. Chinese Journal of Minimally Invasive Surgery, 2020, 20 (3): 230- 233.
13 Okubo Y , Yoshida Y , Yotsukura M , et al. Complex segmentectomy is not a complex procedure relative to simple segmentectomy[J]. Eur J Cardiothorac Surg, 2021, 61 (1): 100- 107.
doi: 10.1093/ejcts/ezab367
14 Nakagawa K , Watanabe SI , Kunitoh H , et al. The lung cancer surgical study group of the Japan clinical oncology group: past activities, current status and future direction[J]. Jpn J Clin Oncol, 2017, 47 (3): 194- 199.
doi: 10.1093/jjco/hyw169
15 Suzuki K . Whack-a-mole strategy for multifocal ground glass opacities of the lung[J]. J Thorac Dis, 2017, 9 (Suppl 3): S201- S207.
16 Okada M , Koike T , Higashiyama M , et al. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study[J]. J Thorac Cardiovasc Surg, 2006, 132 (4): 769- 775.
doi: 10.1016/j.jtcvs.2006.02.063
17 Saji H , Okada M , Tsuboi M , et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial[J]. Lancet, 2022, 399 (10335): 1607- 1617.
doi: 10.1016/S0140-6736(21)02333-3
18 王现国, 刘俊. 肺段切除术和肺楔形切除术治疗直径≤2 cm的外周性肺腺癌围手术期效果分析[J]. 临床外科杂志, 2021, 29 (11): 1044- 1046.
WANG Xianguo , LIU Jun . A retrospective study of segmentectomy and wedge resection in the treatment of peripheral lung cancer with a diameter of≤2 cm[J]. Journal of Clinical Surgery, 2021, 29 (11): 1044- 1046.
19 Li X , Yang H . Comparative study on efficacy of thoracoscopic anatomic segmentectomy and lobectomy in treating pulmonary ground-glass nodules[J]. J BUON, 2021, 26 (1): 65- 71.
20 Huang L , Zheng B , Chen C , et al. To explore clinical value of single-port video-assisted thoracoscopic surgery in elderly patients with non-small cell lung cancer: lobectomy, segmentectomy and lobectomy vs segmentectomy[J]. Zhongguo Fei Ai Za Zhi, 2018, 21 (4): 287- 295.
21 Tane S , Nishio W , Nishioka Y , et al. Evaluation of the residual lung function after thoracoscopic segmentectomy compared with lobectomy[J]. Ann Thorac Surg, 2019, 108 (5): 1543- 1550.
doi: 10.1016/j.athoracsur.2019.05.052
22 Suzuki K , Saji H , Aokage K , et al. Comparison of pulmonary segmentectomy and lobectomy: safety results of a randomized trial[J]. J Thorac Cardiovasc Surg, 2019, 158 (3): 895- 907.
doi: 10.1016/j.jtcvs.2019.03.090
23 Kato H , Oizumi H , Suzuki J , et al. Thoracoscopic wedge resection and segmentectomy for small-sized pulmonary nodules[J]. J Vis Surg, 2017, 3, 66.
doi: 10.21037/jovs.2017.03.22
24 Yoneda KY , Li S , Herth F , et al. Early preclinical experience with a novel endobronchial radiofrequency ablation system for lung cancer treatment[J]. Annu Int Conf IEEE Eng Med Biol Soc, 2019, 2019, 174- 180.
doi: 10.1109/EMBC.2019.8857593
25 Motooka Y , Fujino K , Gregor A , et al. Endobronchial ultrasound-guided radiofrequency ablation of lung tumors and mediastinal lymph nodes: a preclinical study in animal lung tumor and mediastinal adenopathy models[J]. Semin Thorac Cardiovasc Surg, 2020, 32 (3): 570- 578.
doi: 10.1053/j.semtcvs.2020.02.003
26 Ishiwata T , Motooka Y , Ujiie H , et al. Endobronchial ultrasound-guided bipolar radiofrequency ablation for lung cancer: a first-in-human clinical trial[J]. J Thorac Cardiovasc Surg, 2022, 164 (4): 1188- 1197.e2.
doi: 10.1016/j.jtcvs.2021.12.059
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