完全胸腔镜引导下的肺癌微创手术与传统开放手术术后感染发生情况比较

Incidence of infection after complete thoracoscope-guided minimally invasive surgery for lung cancer and conventional open surgery:a comparative study

目的探究完全胸腔镜引导下的肺癌微创手术与传统开放手术术后感染发生的影响。方法选取2013年1月-2016年12月医院胸外科接诊的非小细胞肺癌患者400例作为研究对象,其中行完全胸腔镜手术的患者250例为试验组,行传统开放手术的患者150例为对照组。比较两组患者的手术时间、术中出血量、术中补血量、术后引流量、术后引流时间及住院时间;对两组患者术后感染例数进行统计;对两组患者中感染患者的痰液标本进行收集,并进行病原菌测定;测定两组患者手术前、术后1、3及7d血清中肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)及C-反应蛋白(CRP)的含量。结果试验组患者的术中出血量、术中补血量、住院时间较对照组患者减少(P<0.05);对照组患者感染率为31.33%(47/150),高于试验组患者感染率8.80%(22/250)(χ2=33.348,P<0.001);对照组47例感染患者中检测出病原菌145株,试验组22例感染患者中检测出病原菌77株;术后1、3、7d,两组患者血清中TNF-α、IL-6、MMP-9、CRP含量较术前升高(P<0.05),且试验组患者血清中TNF-α、IL-6、MMP-9、CRP含量低于对照组患者(P<0.05)。结论与传统开放手术相比,完全胸腔镜引导下的肺癌微创手术能够减少患者术后的感染发生率,减少术后患者血清中TNF-α、IL-6、MMP-9及CRP的含量,具有良好的临床效果。

OBJECTIVE To explore the incidence of postoperative infection induced by the complete thoracoscopeguided minimally invasive surgery for lung cancer and conventional open surgery.METHODS A total of 400 patients with non-small cell lung cancer who were treated in thoracic surgery department from Jan 2013 to Dec 2016 were enrolled in the study,250 patients who received the complete thoracoscope-guided minimally invasive surgery were assigned as the experimental group,while 150 patients who underwent the conventional open surgery were set as the control group.The operation duration,intraoperative bleeding volume,intraoperative blood replenishment volume,postoperative drainage volume,postoperative drainage duration and length of hospital stay were observed and compared between the two groups of patients.The patients with postoperative infection were statistically analyzed,the sputum specimens were collected from the patients with the infection,the pathogens were identified,and the levels of serum tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,matrix metalloproteinase-9（MMP-9）and C-reactive protein（CRP）were determined before the surgeries and after the surgeries for 1,3 and7 days.RESULTS The intraoperative bleeding volume and intraoperative blood replenishment volume of the experimental group were significantly less than those of the control group,and the length of hospital stay of the experimental group was significantly shorter than that of the control group（P〈0.05）.The incidence rate of infection of the control group was 31.33%（47/150）,significantly higher than 8.80%（22/250）of the experimental group（χ2=33.348,P〈0.001）.Totally 145 strains of pathogens were isolated from 47 patients with infection in the control group,and 77 strains of pathogens were isolated from 22 patients in the experimental group.The levels of serum TNF-α,IL-6,MMP-9 and CRP of the two groups of patients were significantly higher after the surgeries for 1,3 and 7 days than before the surgeries（P〈0.05）,and the levels of serum TNF-α,IL-6,MMP-9 and CRP of the experimental group were significantly lower than those of the control group（P〈0.05）.CONCLUSIONS As compared with the conventional open surgery,the complete thoracoscope-guided minimally invasive surgery for lung cancer can effectively reduce the incidence of postoperative infection as well as the levels of serum TNF-α,IL-6,MMP-9 and CRP,and it can achieve remarkable clinical effect.