胸腔镜手术对非小细胞肺癌患者快速康复的效果评价

Outcomes of fast trackvideo-assisted thoracoscopic surgery fornon-smallcell lungcancer

目的：胸腔镜快速康复外科治疗非小细胞肺癌患者的临床应用及其效果评价，总结治疗经验。方法回顾性分析海南医学院附属医院2011年10月至2013年10月经手术治疗的240例非小细胞肺癌患者的临床资料，其中经全胸腔镜手术170例（胸腔镜组），传统开胸手术者70例（传统开胸组）。比较两组患者的手术时间、术中失血量、术后胸液总量、胸引管带管时间，以及术后住院时间和并发症发生率；观察麻醉前（T0）、切皮后1 h（T1）、术毕（T2）、术后24 h（T3）和术后48 h（T4）的免疫应激状态相关指标。结果两组均无围术期死亡病例，在出血量、手术时间、术后胸液总量、胸引管带管时间、术后住院时间方面胸腔镜组均优于传统开胸组，差异有统计学意义（t＝－11．0，P ＝0．00；t＝－3．2， P ＝0．00；t＝－12．7，P ＝0．00；t＝－9．4，P ＝0．00；t＝－6．0，P ＝0．00）；但两组患者的术后并发症发生率比较差异无统计学意义（χ2＝1．48，P ＝0．22）。胸腔镜组在术后24 h（T3）和48 h（T4）的免疫因子指标高于传统开胸组，差异具有统计学意义（P ＜0．01）。在外周血中，胸腔镜组在术后24 h（T3）和48 h （T4）的去甲肾上腺素（NE）浓度低于传统开胸组，差异有统计学意义（t ＝－11．81，P ＝0．00；t ＝－20．06，P ＝0．00）。结论胸腔镜外科治疗非小细胞肺癌具有手术时间短、出血量少，以及术后住院时间短、引流量少、应激和免疫反应小等优势，值得广泛应用。

Objective To investigate the outcomes of fast track video-assisted thoracoscopic surgery for non-smallcell lung cancerand summarize the treatment experience.Methods The clinical data of 240 patients with non-smallcell lung cancer treated in the Affiliated Hospital of Hainan Medical College between October 2011and October 2013 were retrospectively analyzed. Among these 240 patients170 were treated by video-assisted thoracoscopic surgery thoracoscopic surgery groupand the other 70 were managed with conventional thoracotomyconventional thoracotomy group.The operation timevolume of blood loss during operationvolume of postoperative chest drainagechest tube intubation timepostoperative hospital stay and incidence of complications were compared between two groupsand the related indicators of immune stress before anesthesiaT01h after skin incisionT1at the end of operationT224 h after operationT3 and 48 h after operationT4 were observed.Results There was no case ofperioperative death in two groups.The operation timevolume of blood loss during operationvolume of postoperative chest drainagechest tube intubation time and postoperative hospital stay in thoracoscopic surgery group were significantly better than those in conventional thoracotomy groupt= - 11.0P = 0.00t = - 3.2P = 0.00t = - 12.7P = 0.00t =-9.4P =0.00t=-6.0P =0.00.Howeverthere was no significant difference in the incidence of＆amp;nbsp;postoperative complications between two groups χ2 = 1.48P = 0.22.The related indicators of immune stress 24 h after operationT3 and 48 h after operationT4 in thoracoscopic surgery group were significantly higher than those in conventional thoracotomy groupP 〈0.01.The concentration of norepinephrineNE in the peripheral blood 24 h after operationT3 and 48 h after operationT4 in thoracoscopic surgery group was lower than that in conventional thoracotomy group t = - 11.81P =0.00t = - 20.06P = 0.00.Conclusions Thoracoscopic surgery has the advantages of shorter operation time and hospitalization timesmaller volumes of blood loss during operation and postoperative drainageless postoperative stress and immune responseand is worthy of application.