背景与目的:肺癌的外科治疗已发生了巨大的变化。微创肌肉非损伤性开胸术对肺叶切除手术是安全、切实可行的,现已成为国外治疗肺癌的主要手段。但目前国内尚未见关于其与预后的相关报道。本研究主要探讨微创肌肉非损伤性手术(Muscle-Sparing)治疗支气管肺癌的手术安全性、彻底性及临床有效性。方法:2001年至今随访超过1年的150例行Muscle-Sparing手术的支气管肺癌病例,其中男性113例,女性37例,平均年龄64.61岁。病理类型:鳞癌63例,腺癌66例,小细胞癌9例,腺鳞癌6例,大细胞癌3例,粘液表皮样癌1例,肉瘤样癌1例,神经内分泌癌1例。病理分期:ⅠA期18例,ⅠB期54例,ⅡA期4例,ⅡB期17例,ⅢA期46例,ⅢB期7例,Ⅳ期4例。手术方式:右侧肺叶切除者76例,右全肺切除者10例,左侧肺叶切除者52例,左全肺切除者12例。术中行肺门及纵隔淋巴结清扫,平均清扫淋巴结6.6组(包括第2组至第11组)。这150例患者随访了12~58个月,平均随访18.6个月。结果:术后支气管切缘阳性者12例,手术后需输血者5例,有4例患者出现乳糜胸,3例发生皮下积液。围术期死亡率为1.3%。术后1年总的生存率为78%,术后3年总的生存率为62%。结论:微创肌肉非损伤性开胸术与传统的胸部后外侧切口开胸手术比较,具有一定优势。微创肌肉非损伤性开胸术操作简单,手术视野充分,几乎可以完成所有的肺癌切除手术,可以作为肺癌手术的常规术式。而且微创肌肉非损伤性开胸术的中期随访结果是令人满意的。 Background and Objectives: Surgical treatment of lung cancer has undergone tremendous changes. Minimally invasive muscle non-invasive thoracotomy for lobectomy surgery is safe and practical, has now become the main means of treatment of lung cancer abroad. However, no relevant reports about its prognosis have been found in China at present. This study mainly focused on the safety, thoroughness and clinical efficacy of Muscle-Sparing in the treatment of bronchogenic carcinoma. Methods: From 2001 to now, 150 cases of bronchogenic carcinoma treated with Muscle-Sparing were followed up for more than one year, including 113 males and 37 females, with an average age of 64.61 years. Pathological types: 63 cases of squamous cell carcinoma, 66 cases of adenocarcinoma, 9 cases of small cell carcinoma, 6 cases of adenosquamous carcinoma, 3 cases of large cell carcinoma, 1 case of mucoepidermoid carcinoma, 1 case of sarcomatoid carcinoma and 1 case of neuroendocrine carcinoma. Pathological stage: 18 cases of stage IA, 54 cases of stage IB, 4 cases of stage IIA, 17 cases of stage IIB, 46 cases of stage IIIA, 7 cases of stage IIIB and 4 cases of stage IV. Surgical methods: right lobe resection in 76 cases, right pneumonectomy in 10 cases, left lobectomy in 52 cases, left pneumonectomy in 12 cases. Intraoperative hilar and mediastinal lymph node dissection, the average lymph node dissection 6.6 (including the second group to the 11th group). The 150 patients were followed up for 12 to 58 months, with an average follow-up of 18.6 months. Results: There were 12 cases with positive bronchial margins and 5 cases with blood transfusion after surgery. Chylothorax was found in 4 cases and subcutaneous effusion in 3 cases. Perioperative mortality was 1.3%. The 1-year overall survival rate was 78% and the 3-year overall survival rate was 62%. Conclusion: The minimally invasive muscle non-invasive thoracotomy has some advantages compared with the traditional open-chest thoracotomy. Minimally invasive muscle non-invasive thoracotomy simple operation, full surgical field of vision, almost all lung resection surgery can be done, can be used as a routine surgical lung cancer surgery. The minimal follow-up of minimally invasive muscle non-invasive thoracotomy was satisfactory.