Objective:To compare the effects of thoracoscopic anatomical segmentectomy and thoracoscopic lobectomy on patients' respiratory function.Methods:Retrospective analysis of 326 patients who underwent thoracoscopic surgery from July 2016 to July 2019(209 patients underwent anatomical segmentectomy, 117 patients underwent lobectomy). According to variables including gender, age, tumor location, smoking history and BMI, two propensity score-matched cohorts including 89 patients respectively were constructed. The patients’ baseline data and respiratory function date of the patients pre-operation and post-operation were analyzed. The measurement data that obey the normal distribution were described by mean±standard deviation, and the t-test was used for comparison between groups; the measurement data of non-normal distribution was described by the median value( P25, P75), and the Wilcoxon rank sum test was used for the comparison between groups; The data was described by frequency, and the chi-square test or Fisher's exact probability method was used for comparison between groups. Results:At the first-month follow-up after surgery, there was no significant difference in the variation of FVC[(0.48±0.40)L vs.(0.34±0.37)L, P=0.215)and FEV1[(0.52±0.46)L vs.(0.43±0.77)L, P=0.364), and in the change rate of FVC(%)[15.23(8.74, 21.25) vs. 14.58(7.75, 19.40), P=0.122], FEV1(%)[17.25(9.56, 22.78) vs. 16.42(9.15, 20.28), P=0.154]and DLCO(%)[18.54(10.88, 25.68)vs. 17.45(9.58, 23.75) P=0.245]. Between the segmentectomy group and lobectomy group, there was a significant difference in the alteration of FVC[(0.50±0.47)L vs. (0.29±0.31)L, P=0.031] and FEV1[(0.44±0.34)L vs.(0.24±0.23)L, P<0.001], the change rate of FVC(%)[14.27(7.87, 22.32) vs. 9.95(5.56, 17.24), P=0.008]、FEV1(%)[15.23(8.36, 22.17)vs. 10.05(5.15, 18.54), P<0.001]and DLCO(%)[13.74(6.24, 19.78) vs. 4.45(-2.32, 13.75), P=0.023]in the 6th month after surgery. The lobectomy group had a higher variation of FEV1[(0.34±0.49)L vs.(0.18±0.26)L, P=0.006] and change rate of FVC(%)[9.28(2.15, 18.94) vs. 5.24(0.52, 11.45), P=0.0032] and FEV1(%)[10.45(3.15, 21.32) vs. 6.50(1.55, 14.24), P<0.001] in the first year after surgery. However, the variation of FVC[(0.29±0.36)L vs.(0.21±0.24)L, P=0.176) and the change rate of DLCO(%)[8.35(2.15, 16.45) vs. 6.23(2.12, 14.54), P=0.143] didn't show a significant difference between the two groups. Conclusion:Whether in the short or the middle postoperative period, segmentectomy can preserve postoperative respiratory function than lobectomy.

目的 评估胸腺瘤WHO分型、Masaoka分期与其预后的相关性.方法 纳入2009～2019年在复旦大学附属华山医院接受手术治疗的胸腺瘤患者468例,其中男234例、女234例,年龄21～83 (49.6±18.7)岁.行胸腔镜手术132例,胸骨正中切口手术336例,平均随访时间(5.7±2.8)年.分析患者的临床资料.结果 胸骨正中切口组术中出血量(178.3±133.5)mL,胸腔镜手术组术中出血量(164.8±184.1)mL,差异无统计学意义(P=0.537).胸骨正中切口组手术时间(3.3±0.7)h,胸腔镜组手术时间(3.4±1.2)h,差异无统计学意义(P=0.376).术后活动性出血、膈神经损伤、乳糜胸并发症在胸腔镜组分别为8例、9例、1例,在胸骨正中切口组分别为37例、31例、7例,差异均无统计学意义(P=0.102,0.402,0.320).WHO病理分型A型、AB型、B1型、B2型、B3型和C型胸腺瘤患者5年累计无进展生存率分别为100.0％、100.0％、95.7％、81.4％、67.5％和50.0％ (P＜0.001).Masaoka Ⅰ～Ⅳ期胸腺瘤患者5年累计无进展生存率分别为96.1％、89.2％、68.6％和19.3％ (P＜0.001).伴重症肌无力患者5年累计无进展生存率为87.3％,无重症肌无力患者为78.2％ (P＜0.001).胸腔镜与胸骨正中切口患者5年累计无进展生存率分别为82.4％和83.8％ (P=0.904).结论 WHO病理分型与Masaoka分期对临床预后有提示意义.伴重症肌无力胸腺瘤患者预后较好,提示早诊断和早治疗对胸腺瘤具有重要意义.