中文摘要：

目的 ：对比胸腔镜肺叶切除与肺段切除在病理ⅠA期（T1aN0M0）肺腺癌中的肿瘤学疗效,同时寻找影响此类患者预后的独立危险因素。方法：回顾性分析自2012年12月—2014年1月连续就诊于南京医科大学第一附属医院的159例ⅠA期肺腺癌患者的临床、病理资料及生存状况。采用Kaplan-Meier法比较两种术式患者的短期疗效,Cox回归分析寻找影响预后的独立危险因素。结果：胸腔镜肺叶切除术3年总体生存率及无进展生存率为88%和85%,肺段切除为97%和96%（P〈0.05）。Cox回归分析结果显示,肿瘤大小、病理亚型均是肿瘤复发（RR=18.219,95%CI：2.484～133.652,P=0.004;RR=2.107,95%CI：1.403～3.163,P〈0.001）和患者死亡（RR=12.765,95%CI：1.332～122.37,P=0.027;RR=2.223,95%CI：1.376～3.499,P=0.001）的独立危险因素。贴壁型、腺泡型、乳头型、微乳头及实性型肺腺癌患者3年总体生存率和3年无进展生存率分别为98%和97%、88%和88%、78%和78%、75%和58%（P〈0.05）。结论 ：肿瘤大小及病理亚型对ⅠA期肺腺癌患者的预后有显著影响,在严格掌握手术适应证的前提下接受肺段切除手术的ⅠA期肺腺癌患者预后不亚于接受肺叶切除术者。

英文摘要：

Objective：This study compared oncologic outcomes between thoracoscopic lobectomy and segmentectomy,as well as detected the relevant independent risk factors in patients with p-stage ⅠA（T1a N0M0） pulmonary adenocarcinoma. Methods：The clinical, pathological, and survival data of 159 cases in stage IA pulmonary adenocarcinoma who underwent pulmonary resection in the First Affiliated Hospital of NJMU from December 2012 to January 2014 were retrospectively analyzed.Kaplan-Meier method was used for analysis of survival,and the Cox Regression analysis was used to examine independent predictors for prognosis. Results： The3-year overall survival rates and progression-free survival rates for the patients who underwent lobectomy were 88% and 85%,respectively, compared with 97% and 96% for the patients who underwent lobectomy（P〈0.05）. Cox Regression analysis showed that tumor size and pathological subtype were the independent prognostic factors on recurrence（RR=18.219,95%CI：2.484~133.652,P=0.004;RR=2.107,95%CI：1.403~3.163,P〈0.001） and death（RR=12.765,95%CI：1.332~122.37,P=0.027;RR=2.223,95%CI：1.376~3.499,P=0.001）. Three-year overall survival rates and progression-free survival rates were 98% and 97%, 88% and 88%, 78% and 78%, and75% and 58%（P〈0.05） for lepidic, acinar, papillary, micropapillary and solid predominant pulmonary adenocarcinoma tumors, respectively. Conclusion：Tumor size and pathological subtype have significant influence on the prognosis of patients in stage IA pulmonary adenocarcinoma. For the patients in stage IA pulmonary adenocarcinoma, the prognosis of thoracoscopy segmentectomy is not second to that of lobectomy on the premise of strictly mastering the surgical indication.