不同VATS切除术式对T_1期NSCLC患者手术相关临床指标、肺功能及炎症反应水平的影响

Influence of different kinds of VATS operation on operation-related clinical index,lung function and inflammatory reaction levels of patients with NSCLC for T_1 stage

目的:探讨VATS肺段和VATS肺叶切除术式对T_1期NSCLC患者手术相关临床指标、肺功能及炎症反应水平的影响。方法:研究对象选取我院2015年6月至2017年6月收治T_1期NSCLC患者共130例,根据手术方案不同分为肺叶切除组(65例)和肺段切除组(65例),分别采用VATS肺段和VATS肺叶切除术式治疗;比较两组患者手术相关临床指标水平、手术前后肺功能指标、炎症反应实验室指标水平及术后并发症发生率。结果:肺叶切除组患者手术操作时间和术中失血量均显著优于肺段切除组(P <0. 05);肺段切除组患者术后引流量、术后引流时间及总住院时间均显著优于肺叶切除组(P <0. 05);两组患者淋巴结数量比较差异无统计学意义(P> 0. 05);肺段切除组患者术后肺功能指标水平均显著高于肺叶切除组(P <0. 05);肺段切除组患者术后炎症反应实验室指标水平均显著低于肺叶切除组(P <0. 05);两组患者术后并发症发生率比较差异无统计学意义(P> 0. 05)。结论:相较于VATS肺叶切除术式,VATS肺段切除术式治疗T_1期NSCLC可有效加快病情康复进程,保护肺部通气功能,并有助于抑制术后全身炎症反应;而VATS肺叶切除术式则能够缩短手术用时,降低医源性创伤程度。

Objective：To investigate the ilffluence of lobectomy and segmentectomy by VATS on operation - related clinical index, lung function and ilfflammatory reaction levels of patients with NSCLC for T1 stage. Methods ：130 patients with NSCLC for early stage were chosen in the period from June 2015 to June 2017 in our hospital and randomly divided into both group including lobectomy group （65 patients） with lobectomy by VATS and segmentectomy group （65 patients） with segmentectomy by VATS, and the operation-related clinical index, the levels of lung function and laboratory index of inflammatory reaction before and after operation and the complication incidence after operation of both groups were compared. Results ：The operation time and intraoperative blood loss amount of lobectomy group were significantly better than segmentectomy group{ P 〈 0.05 ）. The chest drainage volume and time after opera- tion and total hospitalization staying time of segmentectomy group were significantly better than lobectomy group（P 〈 0.05）. There was no significant difference in the detection number of lymph node between 2 groups（P 〉 0.05）. The levels of lung function after operation of segmentectomy group were significantly higher than lobectomy group（ P 〈 0.05 ）. The levels of laboratory index of ilfflammatory reaction after operation of segmentectomy group were significant- ly lower than lobectomy group（ P 〈 0.05 ）. There was no significant difference in the complication incidence after operation between 2 groups （ P 〉 0.05 ）. Conclusion. Compared with lobectomy by VATS, segmentectomy by VATS in the treatment of patients with NSCLC for T1stage can efficiently speed up the rehabilitation process, protect the lung ventilation function and be helpful to inhibit the postoperative systemic ilfflammatory response, lobectomy by VATS application can efficiently shorten the operation time and reduce the iatrogenic tramna degree.