早期非小细胞肺癌胸腔镜与小切口根治性切除的急性期反应比较

Comparison of Video - assisted Thoracoscopic Surgery and Limited Surgery in Treatment for Early Stage Non- small Cell Lung Cancer

目的:观察胸腔镜肺叶切除术和保留前锯肌的小切口开胸手术治疗早期非小细胞肺癌的效果,检测两种手术后患者的急性期反应,比较两种手术患者机体的创伤情况大小。方法:选取天津医科大学附属肿瘤医院肺部肿瘤科临床诊断为I期和部分II期的非小细胞肺癌患者,分为胸腔镜手术组和小切口开胸手术组,比较两种手术患者的围手术期临床效果,并检测患者血清中CRP、TNF-α、IL-6和IL-10的含量,以辅助判断机体的急性期反应程度,比较两种手术对机体的创伤情况。结果:从2005年7月至2007年1月,共有65位患者入组,其中行胸腔镜根治性肺叶切除术30例,保留前锯肌的小切口开胸手术35例,两种手术患者的带管时间、手术时间、术中失血量、术后引流量等无明显差别;胸腔镜手术可以做到系统性淋巴结清扫。和保留前锯肌的小切口开胸手术相比,胸腔镜手术患者术后疼痛较轻,止痛药服用时间短。胸腔镜手术后1天血清CRP、TNF-α、IL-10的含量均低于小切口开胸手术(48.84±16.89vs65.28±19.80;67.54±18.43vs81.38±21.72;55.49±9.87vs74.28±14.97)。结论:胸腔镜肺叶切除术可以做到系统性淋巴结清扫,与小切口的开胸手术相比,胸腔镜肺叶切除术后患者的急性期反应低、对机体的创伤小,胸腔镜肺叶切除术在治疗早期非小细胞肺癌中可能优于保留前锯肌的小切口开胸肺叶切除术。

Objective： To compare video-assisted thoracoscopic surgery. （VATS） with thoractomy in treatment for early stage non-small cell lung cancer （NSCLC）. Acute inflammatory reactions ＂after each type of surgery＂ were evaluated. Methods From July 2005 to January 2007, 65 patients with stage I or partial II NSCLC were collected. Thirty-five patients received VATS and 30 patients received limited thoractomy. Perioperative clinical results were compared and the serum CRP, TNF-α, IL-6 and IL-10 were detected. Results： Between these two groups, no significant difference was found in drainage tube duration, duration of surgery and intraoperative blood loss. The patients who underwent VATS had less pain and shorter period of taking painkillers. The serum levels of CRP, TNF-α and IL-10 were lower in the VATS group. Conclusion： Systemic lymph node dissection can be conducted by VATS. With less inflammatory wactions than limited thoracotomy, VATS may be a better treatment for early stage NSCLC.