全肺切除与肺叶切除患者术后血清CD40L、TNF-α、IL-6水平及心律失常的对比研究

Comparative study on postoperative serum CD40L,TNF-αand IL-6 levels and arrhythmia in patients with pneumonectomy and pulmonary lobectomy

目的探讨肺癌患者行全肺切除与肺叶切除患者术后血清CD40配体(CD40L)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平及心律失常的对比研究。方法回顾性分析2013年3月至2016年3月该院接受肺癌根治手术的120例非小细胞肺癌(NSCLC)患者的临床资料,其中行胸腔镜全肺切除治疗的20例患者作为对照组,采用胸腔镜肺叶切除治疗的100例患者作为观察组。两组淋巴结清扫组数、手术时间、引流时间、术后疼痛评分、术中出血量及住院时间等指标进行比较;两组患者手术前后血清TNF-α、CD40L、IL-6水平及术后并发症情况进行比较。结果观察组手术时间、引流时间、术后疼痛评分、术中出血量及住院时间均显著低于对照组,差异有统计学意义(P<0.05);观察组心率失常发生率(5.00%)显著低于对照组心率失常发生率(45.00%);观察组并发症总发生率(12.00%)显著低于对照组(65.00%),差异均有统计学意义(P<0.05);两组患者手术前后血清TNF-α、CD40L、IL-6比较差异有统计学意义(P<0.05)。结论相较于全肺切除,肺癌患者采用肺叶切除手术、住院、引流时间更短,失血更少、疼痛更轻,且术后炎性反应更轻,心律失常等并发症发生率更低,可作为肺癌的首选手术方法。

Objective To conduct the comparative study on postoperative serum CD40 ligand(CD40 L),tumor necrosis factor-α(TNF-α)and interleukin 6(IL-6)levels and arrhythmia in the patients with pneumonectomy and pulmonary lobectomy.Methods The clinical data in 120 cases of non-small cell lung cancer(NSCLC)treated with lung cancer radical resection in this hospital from March 2013 to March 2016 were retrospectively analyzed,among them 20 cases of thoracoscopic pneumonectomy served as the control group,while the other 100 cases of thoracoscopic pulmonary lobectomy served as the observation group.The number of lymph node dissection,operative time,drainage time,postoperative pain score,intraoperative bleeding volume and hospital stay time were compared between the two groups.Serum TNF-α,CD40 Land IL-6 levels before and after operation and occurrence of complications were compared between the two groups.Results The operative time,drainage time,postoperative pain score,intraoperative bleeding volume and hospital stay time in the observation group were significantly lower than those in the control group,the differences had statistical significance(P<0.05).The incidence rate of arrhythmia in the observation group was 5.00%,which was significantly lower than 45.00%in the control group;the total incidence rate of complications in the observation group was 12.00%,which was significantly lower than 65.00%in the control group,the difference was statistically significant(P<0.05).The serum TNF-α,CD40 Land IL-6 levels before and after operation had statistical difference between the two groups(P<0.05).Conclusion Compared with pneumonectomy,adopting pulmonary lobectomy in the patients with lung cancer has shorter hospital stay time and drainage time,less blood loss,milder pain and slight postoperative inflammatory reaction and lower incidence rate of arrhythmia and other complications,therefore,which can serve as the first choice of operation method for treating lung cancer.