池州市人民医院胸心外科;
目的 旨在比较单孔电视胸腔镜手术(uVATS)和开胸肺叶切除术治疗肿瘤大小>3 cm的非小细胞肺癌(NSCLC)的疗效和安全性。方法 回顾性分析2021年1月1日至2024年12月1日在池州市人民医院接受根治性手术的T2-4N0-2M_0期NSCLC患者，72例接受uVATS手术，32例接受开胸手术。比较两种术式患者围手术期情况。采用Kaplan-Meier法绘制患者总生存时间(OS)、无复发生存时间(RFS)曲线，生存差异行Log-rank检验。通过倾向评分匹配(PSM)获得uVATS患者和开胸手术患者的均衡队列。结果 整体队列中，接受开胸手术的患者更年轻(P=0.040),有合并症史患者比例略低(P=0.049)。PSM后产生26对患者，其术前特征平衡(P>0.05)。与开胸手术组比较，uVATS组术前肿瘤直径略小(60 mm vs. 66.5 mm,P=0.007),术中出血量更少(30 ml vs. 50 ml,P=0.009),在PSM队列中仍然存在差异(P<0.05)。与开胸手术组比较，uVATS组胸管引流量较少(175 ml vs. 250 ml,P=0.049),术后住院时间明显缩短(P<0.001),术后≥2级并发症的风险更低(P=0.028);这些差异在PSM队列中仍然存在(P<0.05)。开胸手术组R_0切除率略高于uVAST组，差异无统计学意义(P>0.05)。全组患者中位随访时间为12.0个月，uVAST组和开胸手术组中位OS均未达，中位RFS相似，差异无统计学意义(P>0.05)。经PSM匹配后，中位随访时间为10.65个月，两组中位OS均未达，中位RFS相似，差异无统计学意义(P>0.05)。在多变量竞争风险分析中，肺气肿(HR=21.838,P=0.030)和R_0切除(HR=0.107,P=0.021)是影响患者OS的因素。结论 对于>3 cm的NSCLC患者，uVATS肺叶切除术是一种安全可行的手术，为患者提供了良好的围手术期和预后。
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基本信息:
DOI：
中图分类号:R734.2
引用信息:
[1]张友明,王海兵,姚杰.单孔VATS与开胸肺叶切除术治疗>3 cm NSCLC的疗效和安全性：一项倾向评分匹配研究[J].临床肿瘤学杂志,2025,30(03):226-232.
基金信息: