胸腔镜肺癌根治术与开胸肺癌根治术对肺癌患者临床疗效的影响及机制

A Study on the Clinical Effect and Mechanisms of Thoracoscopic Radical Resection and Conventional Thoracotomy Resection on Patients with Pulmonary Carcinoma

目的:比较胸腔镜肺癌根治术和传统开胸肺癌根治术治疗肺癌的临床疗效并探讨其可能作用机制。方法:选取2011年3月至2015年3月于本院进行肺癌根治术的120例患者为研究对象,随机分为观察组(胸腔镜手术组)60例与对照组(开胸手术组)60例,比较两组的手术时间、术中出血量、术后引流量和引流管留置时间;并比较两组患者术前1 d及术后1 d、3 d、7 d的血清炎症因子和疼痛物质水平的变化。结果:两组患者在手术时间、手术出血量和术后引流等临床指标方面差异无明显统计学意义(P>0.05);两组肺癌患者术前1 d的血清炎症因子和疼痛物质水平比较无明显统计学意义(P>0.05),而术后1 d、3 d及7 d胸腔镜手术组的细胞炎症因子及疼痛物质血清表达水平均低于对照组(P<0.05),血液流变指标较小,存在显著差异(P<0.05)。结论:相较于传统开胸根治术,胸腔镜肺癌根治术不仅减少了患者体表创口,亦减小了患者的炎症反应和应激反应,且对血液循环的影响亦较小。

Objective： To compare the clinical efficacy of VATS lung resection and traditional open-chest lung radical surgery in the treatment of lung cancer and explore its possible mechanisms. Methods： 120 patients who were treated in our hospital from March2011 to March 2015 were randomly divided into the control group（conventional thoracotomy resection group） and the observation group（thoracoscopic radical resection group）. Then the serum levels of inflammatory mediators（interleukin-1β, IL-4, tumor necrosis factor-α）,pain substances（nitricoxide, 5-hydroxytryptamine prostaglandin E2） of both groups at one day before the operation and at 1st, 3rd and 7th day after the operation were compared. Results： There was no statistically significant difference in the serum levels of inflammatory mediators and pain substances before one day of the surgery between two groups（P〉0.05）. But the serum levels of IL-1β, IL-4, TNF-α, NO,5-HT and PGE2 in both groups at 1st, 3rd and 7th day after the operation of observation group were significantly lower than those of the control group（P〈0.05）. Conclusion： Compared with the traditional open-chest lung radical surgery, thoracoscopic radical resection had a lower degree of inflammatory reaction and stress reaction in the treatment of patients with pulmonary carcinoma.