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Abstract：
We investigated the clinical therapeutic effects and prognosis of video-assisted thoracoscopic surgery (VATS) in mediastinal lymph node dissection of lung carcinoma. A total of 312 patients were divided into high-risk and conventional risk groups according to the severity of the disease. High-risk group (n=137) received thoracoscope-guided anatomical pulmonary segmentectomy and systematic lymph node dissection as well as conventional risk group (n=175) received thoracoscope-guided pulmonary lobectomy and systematic lymph node dissection. The results revealed that there are significant differences in age, gender, location, lymph node resection methods, and histological classification in the two groups (P<0.05). Moreover, in comparison with the high-risk group, T stage was higher in the conventional group and showed significant statistical significance (P<0.01). The analysis of independent risk factors of the above differences showed that T staging and histological classification showed high-risk coefficients for lymph node dissection. The risk coefficient was increased with patients\' age. The 5-year survival rate, disease-free survival, and postoperative recurrence rate of the patients in the two groups all indicated no obvious statistical differences. Consequently, thoracoscope-guided lymph node dissection could enhance the detection rate of lymph node metastasis. For the adenocarcinoma (AD) patients with T staging greater than T1, lymph node dissection could provide more accurate pathological staging. Anatomical pulmonary segmentectomy combined with systematic lymph node dissection should be applied in the treatment of elderly, high-risk, and advanced stage (prothrombin time (PT) state >2 cm, ≤3 cm) patients with non-small cell lung carcinoma (NSCLC). Taken together,thoracoscope-guided lymph node dissection could improve the detection rate of lymph node metastasis. In this case, the complete resection of lesions could be ensured. Besides, normal pulmonary tissues were preserved to the maximum extent with minimal trauma, safety, fast postoperative recovery, and definite long-term therapeutic effects.
摘要：
探讨电视胸腔镜手术(VATS)在肺癌纵隔淋巴结清扫中的临床疗效及预后。根据病情严重程度将312例患者分为高危和常规风险组。高危组（n=137）接受胸腔镜引导下解剖肺段切除术和系统淋巴结清扫术，常规风险组（n=175）接受胸腔镜引导下肺叶切除术和系统淋巴结清扫术。结果显示，年龄存在显著差异，性别,location,淋巴结切除方法,两组组织学分级比较(P<0.05)。此外，与高危人群相比，常规组T分期高于常规组,差异有统计学意义(P<0.01)。上述差异的独立危险因素分析显示，T分期和组织学分类显示淋巴结清扫的高风险系数。危险系数随患者年龄的增加而增加。5年生存率,无病生存,两组患者术后复发率均无明显统计学差异。因此,胸腔镜引导下淋巴结清扫可提高淋巴结转移的检出率。对于T分期大于T1的腺癌（AD）患者，淋巴结清扫可以提供更准确的病理分期。应用解剖型肺段切除联合系统性淋巴结清扫术治疗老年患者,高风险,和晚期（凝血酶原时间（PT）状态>2厘米，≤3cm）非小细胞肺癌（NSCLC）患者。一起来看,胸腔镜引导下淋巴结清扫可提高淋巴结转移的检出率。在这种情况下,可以确保病变的完全切除。此外,正常肺组织以最小的创伤保存到最大程度，安全,术后恢复快,和明确的长期治疗效果。
