电视胸腔镜术在老年小结节非小细胞肺癌患者治疗中的应用研究

Application of Video-assisted Thoracoscopic Surgery in the Treatment of Elderly Patients with snNSCLC

目的:研究电视胸腔镜术在老年小结节非小细胞肺癌(Small nodules in non small cell lung cancer,sn NSCLC)患者治疗中的应用。方法:回顾2009年1月-2011年6月在我院接受电视胸腔镜术治疗的老年sn NSCLC88例患者的临床资料,按照手术方式将所有患者分为电视胸腔镜组与常规开胸组两个小组。电视胸腔镜组行电视胸腔镜术,常规开胸组行常规开胸术。观察两组患者手术指标、疼痛程度评分、手术前后1 d CRP、TNF-α、IL-6等炎性因子水平、术后并发症、1-3年生存率以及复发率等指标。结果:两组患者一般资料比较无统计学上的差异(P>0.05)。电视胸腔镜组术中出血量、术后引流时间、下床活动时间以及疼痛程度评分及术后1 d CRP、TNF-α、IL-6等炎性因子水平及术后并发症发病率均显著低于常规开胸组(P<0.05)。电视胸腔镜组术后1、2、3年生存率显著高于常规开胸组(P<0.05),且术后复发率显著低于常规开胸组(P<0.05)。结论:电视胸腔镜术治疗老年sn NSCLC创口小、恢复快,且有效避免过度激活炎性细胞,降低术后并发症发病率,值得应用于临床。

Objective： To investigate the application of video-assisted thoracoscopic surgery in the treatment of elderly patients with small nodules in non small cell lung cancer（small nodules in non small cell lung cancer, sn NSCLC）. Methods： we reviewed the information of 88 patients received the Television Thoracoscope treatment in our hospital from January 2009 to June 2011. In accordance with the operation mode, the patients were divided into VATS group and conventional thoracotomy group according to the surgery situation. The VATS group with Video-assisted thoracoscopic and the conventional thoracotomy group underwent conventional thoracotomy,two groups were observed before and after operation in patients with index, pain score, CRP, TNF-α, IL-6 and other inflammatory factor level, postoperative complications, 1-3 year survival rate and recurrence rate index. Results： There were no significant differences between two groups in general information（P〉0.05）. The intraoperative bleeding volume, postoperative drainage time, time to ambulation,pain score, CRP, TNF-α, IL-6 and other inflammatory factor levels and the incidence of complications of after operation of the VATS group were significantly lower than those of the conventional thoracotomy group（P〈0.05）. VATS group after 1, 2, 3 year survival rate was significantly higher than that of the conventional thoracotomy group（P〈0.05）. And the recurrence rate was significantly lower than that in conventional thoracotomy group（P〈0.05）. Conclusion： The video assisted thoracoscopic treatment of elderly patients with sn NSCLC has advantages such as a small wound, fast recovery, avoiding excessive activation of inflammatory cells and reducing the incidence of complications rate after operation, it was worth for clinical application.