胸腔镜下解剖性肺段切除术与肺叶切除术治疗早期肺癌的临床效果

Effect analysis of lung resection and lobectomy under the thoracoscope for treatment of early lung cancer

目的对比观察早期肺癌分别采用胸腔镜下解剖性肺段切除术与肺叶切除术的疗效及安全性。方法前瞻性选取2015年5月至2017年6月132例Ⅰ期肺癌患者,根据随机数字进行分组手术,即肺段切除组(63例)和肺叶切除组(69例),分析比较:两组手术时间,术中出血量、清扫淋巴结的个数、术后胸腔引流管留置时间、术后第1天胸液引流量、术后胸液总引流量、引流天数、术后住院时间、术后6个月肿瘤标志物水平、术后1年肺功能以及术后并发症。结果肺段切除组手术时间较肺叶切除组长,术后总引流量较肺叶切除组少,住院天数较肺叶切除组短,差异均具有显著性(P<0.05)。两组术中出血量、清扫淋巴结的个数、术后第1天引流量、引流天数以及术后胸腔引流管留置时间差异均无显著性(P>0.05)。两组术后血清癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、肿瘤坏死因子α(TNF-α)均低于术前,两组间差异无显著性(P>0.05)。两组术后1年肺活量(FVC)、第1秒用力呼气量与用力肺活量比值(FEV1%)、最大通气量(MVV)均较术前降低(P<0.05),但肺段切除组术后FVC、FEV1、MVV 3项指标下降较肺叶切除组低(P<0.05)。两组术后并发症发生率(9.52%vs.14.49%)比较,差异无显著性(P>0.05)。结论胸腔镜下肺段切除术与肺叶切除术治疗早期肺癌的疗效均较好,但胸腔镜下肺段切除术对肺功能的保护作用明显优于肺叶切除术。

Objective To discuss the effect of lung resection and lobectomy under the thoracoscope for treatment of early lung cancer.Methods From May 2015 to June 2017,132 cases ofⅠperiod lung cancer patients,according to the random number,were divided into lung resection group（ 63 cases） and lobectomy group（ 69 cases）. The operation time,intraoperative blood loss,cleaning the number of lymph nodes,postoperative chest drainage tube indwelling time,postoperative day 1 thoracic fluid flow rate and postoperative thoracic fluid flow and drainage days,6 months postoperative hospital stay,postoperative tumor marker levels and pulmonary function 1 year after surgery,and postoperative complications in the two groups were compared. Results The operation time in lung resection group was longer than that in lobectomy group,postoperative hospitalization days was shorter than that of lobectomy group（ P〈0. 05）. Differences of intraoperative blood loss,cleaning the number of lymph node and postoperative day 1 days flow and drainage and postoperative chest drainage tube indwelling time in the two groups were not statistically significant（ P〈0. 05）. Postoperative CEA,CYFRA21-1,TNF-α were lower than the preoperative ones,there was no significant difference between the two groups（ P〈0. 05）. Postoperative FVC,FEV1%,MVV were lower than preoperative ones（ P〈0. 05）,but postoperative FVC,FEV1%,MVV of the pulmonary resection group were 3 indicators fall lower than those of lobectomy group（ P〈0. 05）. The incidence of postoperative complications in the two groups（ 9. 52% vs. 14. 49%） had no significant difference. Conclusion The curative effect of lung resection and lobectomy under the thoracoscope on the treatment of early lung cancer are good,but the protection of lung funtion with lung segment resection is obviously better than that of the the lobectomy.