单孔胸腔镜下肺叶切除术治疗肺功能中重度减低的周围型肺癌的效果

Effect of single-port thoracoscopic lobectomy in the treatment of peripheral lung cancer with moderate-tosevere reduction of lung function

目的探讨单孔胸腔镜下肺叶切除术治疗肺功能中重度减低的周围型肺癌患者的效果。方法选取我院肺功能中重度减低的周围型肺癌患者86例,按照随机数字表法分为单孔组和三孔组,每组43例。单孔组患者采用单孔胸腔镜下肺叶切除治疗,三孔组采用常规三孔胸腔镜下肺叶切除术治疗。观察2组围术期指标,比较2组术前及术后3 d、7 d第1秒用力呼气容积占预计值的百分比(FEV1%pred)、用力肺活量占预计值的百分比(FVC%pred)、最大分钟通气量占预计值的百分比(MVV%pred)等肺功能指标,降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)等炎症因子,T淋巴细胞亚群CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)及并发症发生情况。结果与三孔组比较,单孔组术后下床活动及术后住院时间缩短,手术时间延长,术中出血量及术后3 d VAS评分降低,差异均有统计学意义(P<0.05)。2组术后3 d及7 d的FEV1%pred、FVC%pred、MVV%pred均较术前降低(P<0.05),术后7 d单孔组FEV1%pred、FVC%pred、MVV%pred高于三孔组(P<0.05)。术后3 d,2组炎症因子均较术前升高(P<0.05),且单孔组低于三孔组(P<0.05);术后7 d,2组血清PCT、TNF-α、CRP水平出现回落,且单孔组低于三孔组(P<0.05)。术后3 d,2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均较术前降低(P<0.05),且单孔组高于三孔组(P<0.05);术后7 d,2组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均有回升,且单孔组高于三孔组(P<0.05)。2组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论单孔胸腔镜下肺叶切除术治疗肺功能中重度减低的周围型肺癌安全、有效,能获得与常规三孔胸腔镜手术相近的疗效,其在机体炎症、免疫功能及术后早期恢复方面更具优势,且因其手术创伤小,切口小,患者更易接受。

Objective To investigate the effect of single-port thoracoscopic lobectomy in the treatment of patients with peripheral lung cancer and moderate-to-severe reduction of lung function.Methods A total of 86 patients with peripheral lung cancer and moderate-tosevere reduction of lung function in our hospital were selected and divided into the single-port group and three-port group by random number table method,with 43 cases in each group.Patients in the single-port group were treated with single-port thoracoscopic lobectomy,and patients in the three-port group were treated with conventional three-port thoracoscopic lobectomy.The perioperative indicators were recorded,and the pulmonary function indicators including the percent of predicted forced expiratory volume in one second(FEV1%pred),percent of predicted forced vital capacity(FVC%pred),and percent of predicted maximum minute ventilation(MVV%pred),inflammatory factors including the procalcitonin(PCT),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),T lymphocyte subsets including CD3^(+),CD4^(+),CD4^(+)/CD8^(+)before surgery and 3 days and 7 days after surgery,and complications in the two groups were compared.Results Compared with the threeport group,the single-port group had shorter postoperative ambulation time and postoperative hospital stay,longer operation time,lower intraoperative blood loss and VAS score 3 days after operation,with statistically significant differences(P<0.05).The FEV1%pred,FVC%pred and MVV%pred 3 days and 7 days after surgery in the two groups were lower than those before surgery,the FEV1%pred,FVC%pred and MVV%pred 7 days after surgery in the single-port group were higher than those in the three-port group(P<0.05).The inflammatory factors 3 days after surgery in the two groups were higher than those before operation(P<0.05),and those in the single-port group were lower than those in the three-port group(P<0.05);the serum levels of PCT,TNF-αand CRP 7 days after surgery in the two groups decreased,and those in the singleport group were lower than those in the three-port group(P<0.05).The CD3^(+),CD4^(+),CD4^(+)/CD8^(+)3 days after surgery in the two groups were lower than those before surgery(P<0.05),and those in the the single-port group were higher than those in the three-port group(P<0.05);the CD3^(+),CD4^(+),CD4^(+)/CD8^(+)7 days after surgery in the two groups all increased,and those in the single-port group were higher than those in the three-port group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Single-port thoracoscopic lobectomy in the treatment of peripheral lung cancer with moderate-to-severe reduction of lung function is safe and effective,which can achieve similar curative effect to conventional three-port thoracoscopic surgery.It has advantages in inflammation,immune function and early postoperative recovery,and is more acceptable to patients for its small surgical trauma and incision.