摘要
目的研究胸腔镜引导下行肺癌根治术后感染发生情况及对患者的结合珠蛋白(haptoglobin,Hp)、α1-酸性糖蛋白(α1-Acid glycoprotein,AAG)、α1-抗胰蛋白酶(α1-Antitrypsin,AAT)及血清C-反应蛋白(CRP)等血清急性时相反应蛋白水平的影响。方法选择2015年3月-2017年3月于医院治疗的非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者84例为研究对象,随机分为试验组与对照组,各42例,对照组患者采用开胸手术,试验组患者采用胸腔镜下肺癌根治术。比较两组患者淋巴结清扫、出血量等手术指标,记录住院期间感染发生情况,抽取手术前、手术3 d、7 d肘静脉血,检测血清CRP、降钙素原(Procalcitonin,PCT)、肿瘤坏死因子(Tumor necrosis factor,TNF-α)和Hp、AAG和AAT。结果试验组手术时间、出血量、术后引流量分别为(103.43±12.43)min、(154.56±21.23)ml、(45.34±5.45)ml低于对照组(P<0.001),两组淋巴结清扫数差异无统计学意义(P=0.831);试验组术后感染率为7.14%((3/42))低于对照组23.81%(10/42)(P=0.001);两组术后CRP、Hp、AAG、AAT升高,且治疗3 d和7 d试验组分别为(8.65±0.34)g/L、(3.68±0.32)g/L、(94.34±8.08)mg/dl、(315.56±23.54)mg/dl和(7.04±0.28)g/L、(3.21±0.23)g/L、(84.78±7.78)mg/dl、(269.56±19.34)mg/dl均低于对照组(P<0.05);两组术后血清PCT、TNF-α升高,且治疗3 d和7 d试验组分别为(9.76±0.45)ng/dl、(3.12±0.34)mg/dl和(6.74±0.72)ng/dl、(2.34±0.26)mg/dl低于对照组(P<0.05)。结论胸腔镜引导下行肺癌根治术较开胸手术创伤更小,术后炎性因子控制效果更优,能降低术后感染率。
OBJECTIVE To study the incidence of infection after thoracoscopy-guided radical resection of lung cancer and its effect on serum levels of acute phase reaction proteins such as haptoglobin(Hp),alpha-1-acid glycoprotein(AAG),alpha-1-antitrypsin(AAT)and serum C-reactive protein(CRP).METHODS Eighty-four patients with non-small cell lung cancer(NSCLC)who were treated in the hospital from Mar.2015 to Mar.2017 were enrolled and randomly divided into the experimental group and the control group,with 42 cases in each group.The control group was treated with thoracotomy and the experimental group was treated with thoracoscopic radical resection of lung cancer.Surgical indicators such as lymph node dissection and bleeding volume were compared between the two groups.The incidence of infection during hospitalization was recorded.The blood samples of elbow vein were collected before operation,3 days and 7 days after operation.The serum C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor(TNF-α)and haptoglobin(Hp),acidic glycoprotein(AAG)and alpha-1-antitrypsin(AAT)were measured.RESULTS The operation time,blood loss and postoperative drainage volume of the experimental group were(103.43±12.43)min,(154.56±21.23)ml,(45.34±5.45)ml,significantly lower than those of the control group(P<0.001),whereas there was no significant difference in lymph node dissection between the two groups(P=0.831).The postoperative infection rate was 7.14%((3/42))in the experimental group and 23.81%(10/42)in the control group(P=0.001).The postoperative CRP,Hp,AAG and AAT increased in both groups,and the values of the treatment group were(8.65±0.34)g/L,(3.68±0.32)g/L,(94.34±8.08)mg/dl,(315.56±23.54)mg/dl and(7.04±0.28)g/L,(3.21±0.23)g/L,(84.78±7.78)mg/dl,(269.56±19.34)mg/dl on the 3rd day and 7 th day after treatment,respectively which were significantly lower than those of the control group(P<0.05).Serum PCT and TNF-αlevels were increased in both groups,and the values in the treatment group were(9.76±0.45)ng/dl,(3.12±0.34)mg/dl,and(6.74±0.72)ng/dl,(2.34±0.26)mg/dl on the 3rd day and 7th day after treatment,respectively.which were significantly lower than those of the control group(P<0.05).CONCLUSION Compared with open thoracic surgery,the wound is smaller after thoracoscope-guided radical resection of pulmonary carcinoma,the postoperative control effect of related inflammatory factors is better,and this treatment can significantly reduce the postoperative infection rate.
作者
马宏境
黄少祥
刘彬
吴文娟
曾妮
MA Hong-jing;HUANG Shao-xiang;LIU Bin;WU Wen-juan;ZENG Ni(Tianjin Fifth Central Hospital,Tianjing300450,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第11期1677-1681,共5页
Chinese Journal of Nosocomiology
基金
天津市科委抗癌重大专项攻关计划基金资助项目(12ZCDZSY16100)
关键词
胸腔镜
开胸手术
肺癌根治术
感染
急性期反应蛋白
Thoracoscope
Open thoracic surgery
Radical resection of pulmonary carcinoma
Infection
Acute phase reaction protein
