目的：探讨腹腔镜联合胸腔镜（双镜）一期切除结直肠癌肺转移的疗效及预后相关因素。 方法：回顾性分析35 例结直肠癌同时肺转移患者的临床资料，其中17 例进行了双镜一期手术切除（双 镜手术组），术后接受化疗；其余18 例仅接受全身化疗（非手术组），比较两组疗效并分析双镜手术 患者的预后因素。 结果：双镜手术组患者原发性病灶及肺转移灶均达到R0 切除。双镜手术组与非手术组1、2 年生存率 分别为82.3%、44.4%（P=0.028） 和52.3%、22.2%（P=0.001）。单因素分析显示， 肺转移瘤数量 （P=0.002）及纵膈淋巴结阳性（P<0.001）与患者术后生存有关，而患者的性别、年龄，原发肿瘤部位、 病理类型、T 分期，肺转移瘤大小、切除方式，手术前CEA 水平，化疗方案均与其术后生存时间无关 （均P>0.05）；多因素分析显示，肺转移瘤数量（P=0.005）、纵膈淋巴结转移（P=0.006）是患者术 后的预后独立影响因素。 结论：结直肠癌肺转移双镜一期手术切除可提高患者的总生存率；肺转移瘤数量及有无纵膈淋巴结转 移是影响术后预后的独立因素。
Efficacy of one-stage resection of colorectal cancer and lung metastases by combined laparoscopic and thoracoscopic approach and prognostic factors
Objective: To investigate the efficacy and related prognostic factors in one-stage resection of colorectal cancer and lung metastases by combined laparoscopic and thoracoscopic (biscopic) approach. Methods: The clinical data of 35 patients with colorectal cancer and pulmonary metastases were retrospectively analyzed. Of the patients, 17 cases underwent biscopic one-stage resection followed by systemic chemotherapy (biscopic surgery group), and 18 cases received systemic chemotherapy only (non-surgery group). The treatment efficacy of the two groups was compared and prognostic factors for patients undergoing biscopic surgery were analyzed. Results: Both the primary tumor and pulmonary metastases achieved R0 resection in biscopic surgery group. The 1- and 2-year survival rate was 82.3% and 52.3% in biscopic surgery group, and 44.4% and 22.2% in non-surgery group respectively (P=0.028; P=0.001). Univariate analysis showed that the number of lung metastases (P=0.002) and positive mediastinal lymph nodes (P<0.001) were associated with the postoperative survival of the patients, while gender, age, the location of the primary tumor, pathological type, T stage, lung metastasis size and type of resection, preoperative CEA level and chemotherapy regimens were irrelevant to their postoperative survival (all P>0.05). Multivariate analysis indicated that the number of metastases (P=0.005) and mediastinal lymph node involvement (P=0.006) were independent influential factors for postoperative prognosis of the patients. Conclusion: Biscopic one-stage resection for colorectal cancer and lung metastases can improve the overall survival of the patients, and number of metastases and mediastinal lymph node involvement are the independent influential factors for postoperative prognosis.