胸腔镜与传统开胸手术对早期非小细胞肺癌治疗的比较研究

Comparative study between video-assisted thoracoscope lobectomy and traditional thoracotomy in the treatment of patients with non-small cell lung cancer at early stage

目的探讨胸腔镜肺叶切除术治疗早期非小细胞肺癌的围手术期治疗效果。方法通过比较同时期同手术组接受全胸腔镜肺叶切除治疗非小细胞肺癌和接受传统开胸手术的病人各21例的临床资料,比较手术时间、术中失血量、淋巴结清扫的数量、胸腔引流管术后72小时内的引流量、患者术后的主观疼痛评分、术后住院时间及医疗费用;测定术前、术后1天、5天的血清C反应蛋白(CRP)、白细胞介素6(IL-6)、白细胞介素12(IL-12)。比较两组间的差异。结果胸腔镜组手术时间显著长于开胸组(t=2.137,P=0.042)P<0.05;术中淋巴结清扫个数两组无显著差别(t=-0.25,P=0.860);术中失血量(t=-2.436,P=0.033);术后疼痛程度(χ2=20.537,P=0.000)、术后72小时内胸管引流量(t=-2.528,P=0.020)、术后住院时间(t=-3.851,P=0.001)胸腔镜组明显少于开胸组;术前两组血清CRP IL-6、IL-12无显著差异,而术后胸腔镜组的CRP(术后1天t=3.851,P=0.001;术后5天t=2.471,P=0.033)、IL-6(术后1天t=7.844,P=0.000;术后5天t=2.845,P=0.010)显著低于开胸组,IL-12(术后1天t=-7.442,P=0.000;术后5天t=-8.335,P=0.000)显著高于开胸组;术后第5天胸腔镜组的血清学指标与术前已无统计学差别。结论胸腔镜治疗早期非小细胞肺癌具有创伤小、恢复快的优点,达到开胸手术的根治要求,对患者细胞免疫功能损伤轻,有利于改善预后。

Objective To evaluate the clinical effect of video-assist thoracoscope surgery （VATS） lobectomy in the treatment of patients with non-small cell lung cancer （NSCLC） at early stage. Methods 42 patients with NSCLC at early stage were evenly divided into two groups. The group A was given VATS lobectomy, and the group B was treated with traditional thoracotomy. Their perioperative clinical data were compared between the two groups, including operation time, blood loss, lymph node dissection count, cost of hospital stay, and levels of CRP, IL-6 and IL-12. Results The operation time was obviously longer in the group A than in the group B （ t = -2. 436, P = 0. 033 ）. There was no significant difference on the count of lymph node dissection （t = -0. 25, P = 0. 860 ）. The duration of postoperative hospital stay was significantly shorter in the group A than in the group B （t = -3.851, P =0. 001 ）. The degree of sub- jeetive postoperative pain was significantly lighter in the group A than in the group B 2 = 20. 537, P = 0. 000 ）. There was no significant difference on the serum levels of CRP, IL-6 and IL-12 before operation between the two groups. The serum levels of CRP and IL-6 on the first and fifth days after operation were significantly lower in the group A than in the group B, but the level of IL-12 was significantly higher in the group A than in the group B. Conclusion VATS lobectomy has the advantages of minimal invasive and quick recovery in the treatment of patients with NSCLC at early stage.