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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2019, Vol. 12 ›› Issue (04) : 473 -477. doi: 10.3877/cma.j.issn.1674-6902.2019.04.014

论著

肺段切除在早期浸润性肺腺癌中的应用评价
武强1, 王霄霖2, 李守剑1, 刘庆文2, 唐桂旺2, 陆世春2,†(), 束余声2,†()   
  1. 1. 116044　大连，大连医科大学；225001　扬州，江苏省苏北人民医院胸外科
    2. 225001　扬州，江苏省苏北人民医院胸外科
  • 收稿日期:2019-04-17 出版日期:2019-08-20
  • 通信作者: 陆世春, 束余声
  • 基金资助:
    扬州市科技项目(YZ2017071)

Evaluation of segmentectomy in patients with early primary lung invasive adenocarcinoma

Qiang Wu1, Xiaolin Wang2, Shoujian Li1, Qingwen Liu2, Guiwang Tang2, Shichun Lu2,†(), Yusheng Shu2,†()   

  1. 1. Dalian Medical University, Dalian 116000, China; Department of Thoracic Surgery, Northern Jiangsu People′s Hospital, Clinical Medical School of Yangzhou University, Yangzhou 225001, China
    2. Department of Thoracic Surgery, Northern Jiangsu People′s Hospital, Clinical Medical School of Yangzhou University, Yangzhou 225001, China
  • Received:2019-04-17 Published:2019-08-20
  • Corresponding author: Shichun Lu, Yusheng Shu
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引用本文：

武强, 王霄霖, 李守剑, 刘庆文, 唐桂旺, 陆世春, 束余声. 肺段切除在早期浸润性肺腺癌中的应用评价[J]. 中华肺部疾病杂志(电子版), 2019, 12(04): 473-477.

Qiang Wu, Xiaolin Wang, Shoujian Li, Qingwen Liu, Guiwang Tang, Shichun Lu, Yusheng Shu. Evaluation of segmentectomy in patients with early primary lung invasive adenocarcinoma[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(04): 473-477.

目的

探讨亚肺叶切除和肺叶切除在原发浸润性肺腺癌中的预后效果。

方法

通过HIS系统(Hospital Information System)选择肿瘤大小在0～2 cm的原发浸润性肺腺癌患者作为研究对象。通过倾向性匹配分析来消除潜在的偏倚，使用Kaplan-Meier生存分析比较亚肺叶切除组和肺叶切除组的总体生存时间。

结果

共纳入了154例肿瘤大小为0～2 cm的浸润性肺腺癌患者，其中肺段切除31例，肺叶切除123例，3年生存时间的分析的结果显示：肺段切除的预后和肺叶切除相似(OS: HR, 1.29(0.13-12.81)，P＝0.81)；154例浸润性腺癌患者术后10例出现并发症，其中肺段切除组1例(3.2%)出现持续漏气(超过7 d)；肺叶切除组出现9例，2例出现持续漏气，1例出现肺部感染，2例出现皮下气肿，1例出现胸腔积液。基于年龄、性别、吸烟史、慢性病史、肿瘤大小及淋巴结清扫数目等变量进行倾向性匹配分析获得28对肺段切除和肺叶切除病例，两组的近期总体生存时间无明显统计学差异性(OS: HR, 2.50(0.12-52.20)，P＝0.38)。

结论

肺段切除可作为早期原发浸润性肺腺癌的可选治疗方法。

关键词: 肺腺癌, 浸润性肺腺癌, 肺段切除, 肺叶切除
Objective

To compare the prognostic effect of segmentectomy and lobectomy for the patients with early primary lung invasive adenocarcinoma (PLIA).

Methods

Hospital Information System (HIS) was used to identify the patients who underwent sublobar resection or lobectomy for PLIA with 0-2 cm in size. Propensity score-matching (PSM) was used to adjust the potential confounding. The Kaplan-Meier method was used to assess the overall survival (OS) and lung cancer-specific survival (LCSS).

Results

In this study, 154 patients were obtained from HIS, of whom 31 patients underwent segmentectomy and 123 underwent lobectomy. The prognosis of underwent segmentectomy was equivalent to underwent lobectomy in terms of 3-year OS (OS: HR, 1.29 (0.13-12.81), P=0.81). 10 cases of postoperative complications in these patients, 1 case (3.2%) had continuous air leakage (over 7 d) in underwent segmentectomy. 9 cases(7.3%) in underwent lobectomy, 2 cases of continuous air leakage, 1 case of pulmonary infection, 2 cases of subcutaneous emphysema, 1 case of pleural effusion. Based on age, sex, smoking history, chronic history, tumor size and number of lymph node dissection, analysis of tendentious matching to obtain 28 cases of lung segment resection and lobectomy. And segmentectomy is similar to lobectomy after the PSM (OS: HR, 2.50 (0.12-52.20), P=0.38).

Conclusion

Segmentectomy can be considered as an alternative choice for the patients with PLIA.

Key words: Adenocarcinoma of lung, Invasive adenocarcinoma, Segmentectomy, Pneumonectomy
表1 肿瘤大小≤2浸润性肺腺癌行肺段或肺叶切除的一般临床资料
临床资料 肺段切除(n＝31) 肺叶切除(n＝123) P值
PSM值 PSMa
年龄[a(±s)] 55.2±11.0 57.7±9.4 0.21 0.95
男性(%) 16(51.6) 54(43.9) 0.28 1
吸烟史(%) 15(48.4) 54(43.9) 0.82 1
肿瘤大小≤1 cm(%) 13(41.9) 13(10.7) <0.001 0.57
慢性病史(%) 1(3.2) 45(36.6) 0.4 1
术前CT表现        
  亚实性结节 31 103 0.01 无
  实性结节 0 20    
N1站淋巴结清扫     0.008 无
  (0～10)(%) 31(100) 102(82.9)    
  >10(%) 0(0) 21(17.1)    
N2站淋巴结清扫     <0.001 无
  (0～10)(%) 31(100) 79(64.2)    
  >10(%) 0(0) 44(35.8)    
表2 两组患者伴随疾病或既往病史汇总表[n(%)]
伴随疾病或既往病史 肺段切除(31) 肺叶切除(123)
高血压 0(0) 34(27.64)
糖尿病 0(0) 5(4.07)
冠心病 0(0) 2(1.63)
室性早搏 0(0) 1(0.81)
心房纤颤 0(0) 1(0.81)
脑缺血或脑梗死 0(0) 4(3.25)
慢性支气管炎 1(3.2) 0(0)
支气管哮喘 0(0) 1(0.81)
肝硬化 0(0) 1(0.81)
肺结核 1(3.2) 3(2.44)
良性肿瘤 0(0) 7(5.69)
鼻息肉 0(0) 2(1.63)
图1 A：肿瘤大小为0～2 cm肺浸润性腺癌行肺段切除和肺叶切除后近期总体生存时间的比较，两组无统计学差异；B：肿瘤大小为0～2 cm肺浸润性腺癌经倾向性匹配分析后肺段切除和肺叶切除后近期总体生存时间的比较，两组无统计学差异。HR, hazard ratio, CI, confidence interval.
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