摘要
目的探讨单孔全胸腔镜下解剖性肺段切除术在早期非小细胞肺癌(NSCLC)患者中的应用效果。方法将该院2019年1月至2020年4月收治的131例NSCLC患者作为研究对象,收集其临床资料,并根据患者手术方法将其分为对照组74例和观察组57例。对照组采用单孔全胸腔镜肺叶切除术结合淋巴结清扫,观察组采用单孔全胸腔镜下解剖性肺段切除术结合淋巴结清扫。对比两组手术相关指标[手术时间、术中出血量、胸腔引流时间、术后疼痛视觉模拟量表(VAS)评分、术后住院时间及治疗费用]、淋巴结清扫情况、手术前后肺功能指标[第1秒呼气用力容积(FEV1)、用力肺活量(FVC)、峰值呼气流速(PEF)]水平、术中中转情况、术后应激指标[皮质醇(Cor)、肾上腺素(E)及去甲肾上腺素(NE)]水平及术后并发症发生情况。结果两组手术时间、术中出血量、治疗费用比较,差异均无统计学意义(P>0.05);观察组胸腔引流时间、术后住院时间均短于对照组,术后VAS评分低于对照组,差异均有统计学意义(P<0.05)。两组术中淋巴结清扫总数目、纵隔淋巴结清扫数目比较,差异均无统计学意义(P>0.05)。术后3个月,两组FEV1、FVC、PEF均高于术前,且观察组FEV1、FVC、PEF均高于对照组,差异均有统计学意义(P<0.05)。观察组术中中转多孔率及中转开胸率均低于对照组(P<0.05)。观察组术后Cor、E及NE水平均低于对照组(P<0.05)。两组术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论单孔全胸腔镜下解剖性肺段切除术不会增加早期NSCLC患者术后并发症,且术中中转率更低,在改善患者肺功能、减少术后应激、促进其术后早期快速康复方面优于单孔全胸腔镜肺叶切除术。
Objective To explore the application effect of single-hole total thoracoscopic anatomical segmentectomy in patients with early non-small cell lung cancer(NSCLC).Methods A total of 131 early NSCLC patients admitted to the hospital from January 2019 to April 2020 were enrolled as study subjects,their clinical data were collected,and they were divided into 74 cases in the control group and 57 cases in the observation group according to different surgical methods.The control group was treated with single-hole total thoracoscopic pulmonary lobectomy combined with lymph node dissection,while the observation group was treated with single-hole total thoracoscopic anatomical segmentectomy combined with lymph node dissection.The surgical related indexes[operation time,intraoperative blood loss,chest drainage time,postoperative visual analog scale(VAS)score for pain,postoperative hospitalization time and treatment cost]levels,lymph node dissection,pulmonary function indexes[expiratory exertion volume in one second(FEV 1),exertion lung capacity(FVC),peak expiratory flow rate(PEF)]levels before and after surgery,conversion to other surgery,postoperative stress indicators[cortisol(Cor),epinephrine(E)and noradrenaline(NE)]levels and postoperative complications were compared between the two groups.Results There were no statistically significant differences in operation time,intraoperative blood loss and treatment cost between the two groups(P>0.05).The chest drainage time and postoperative hospitalization time in the observation group were shorter than those in the control group,and postoperative VAS score was lower than that in the control group,with statistically significant differences(P<0.05).There were no significant differences in the total number of intraoperative lymph node dissection and number of mediastinal lymph node dissection between the two groups(P>0.05).At 3 months after surgery,the levels of FEV 1,FVC and PEF were higher than those before surgery in both groups,and the levels of FEV 1,FVC and PEF in the observation group were higher than those in the control group,with statistically significant differences(P<0.05).The rates of conversion to multi-hole surgery and conversion to thoracotomy in the observation group were lower than those in the control group(P<0.05).The levels of Cor,E and NE in the observation group were lower than those in the control group(P<0.05).There was no significant difference in total incidence of postoperative complications between the two groups(P>0.05).Conclusion Single-hole total thoracoscopic anatomical segmentectomy does not increase postoperative complications in patients with early NSCLC,with lower rate of conversion to other surgery.It is superior to single-hole total thoracoscopic pulmonary lobectomy in improving pulmonary function,reducing the postoperative stress and promoting postoperative early fast recovery.
作者
王孝彬
郭一泽
马骏
WANG Xiaobin;GUO Yize;MA Jun(Department of Thoracic Surgery,the Second Affiliated Hospital of Air Force Medical University,Xi′an,Shaanxi 710038,China)
出处
《检验医学与临床》
CAS
2024年第23期3499-3503,共5页
Laboratory Medicine and Clinic
基金
陕西省重点研发计划项目(2022SF-230)。
关键词
单孔全胸腔镜
解剖性肺段切除术
肺叶切除术
非小细胞肺癌
淋巴结清扫
肺功能
single-hole total thoracoscope
anatomical segmentectomy
pulmonary lobectomy
non-small cell lung cancer
lymph node dissection
pulmonary function
