电视胸腔镜肺叶切除术治疗31例早期非小细胞肺癌的中期随访研究及免疫功能分析

Mid-term follow-up study and immune function analysis of video-assisted thoracoscopic lobectomy for 31 cases of early non-small cell lung cancer

目的 探讨电视胸腔镜肺叶切除术治疗早期非小细胞肺癌（NSCC）的临床效果及对患者免疫功能的影响.方法 选取2015年1月至2015年12月运城市中心医院收治的63例NSCC早期患者,根据术式分为观察组（31例）与对照组（32例）.对照组行传统开胸肺叶切除术,观察组行电视胸腔镜肺叶切除术.对比两组手术及术后恢复情况、术前及术后3 d免疫功能[T淋巴细胞亚群（CD3＋、CD4＋、CD4＋/CD8＋）]、术后不同时段疼痛情况、术后并发症发生率.术后随访1年,统计两组复发率.结果 两组手术用时及术中淋巴结清扫数目比较差异未见统计学意义（P〉0.05）;与对照组比较,观察组术中出血量少、切口长度短、住院时间短（P〈0.05）.术前两组CD3＋、CD4＋、CD4＋/CD8＋比较差异未见统计学意义（P〉0.05）;术后3 d,两组CD3＋、CD4＋、CD4＋/CD8＋较手术前下降（P〈0.05）,但观察组CD3＋、CD4＋、CD4＋/CD8＋高于对照组（P〈0.05）.观察组术后1、3、7 d疼痛视觉模拟评分均低于对照组（P均〈0.05）.观察组术后并发症发生率（6.45％）低于对照组（28.13％）,P〈0.05.术后随访1年,观察组复发率（3.23％）与对照组（9.38％）比较差异未见统计学意义（P〉0.05）.结论 电视胸腔镜肺叶切除术治疗早期NSCC可取得与传统开胸手术相同的淋巴结清扫效果,但该术式更具微创性,对机体免疫功能影响小,且疼痛轻,可有效降低术后并发症发生率.

Objective To investigate the clinical effect of video-assisted thoracoscopic lobectomy on nonsmall-cell carcinoma （ NSCC ） patients in early stage and to study its effect on patients＇ immunologic function .Methods Sixty-three patients with early NSCC who were treated in Yuncheng Central Hospital from January 2015 to December 2015 were selected and divided into observation group （ n =31 ） and control group （ n =32 ） according to surgical procedures .Patients in control group underwent conventional thoracotomy lobectomy , and patients in observation group underwent video-assisted thoracoscopic lobectomy .The operation condition and postoperative recovery , the immunologic function , including T lymphocyte subsets （ CD3 ＋, CD4 ＋, CD4 ＋/CD8 ＋） before operation and 3 days after operation , the postoperative visual analogue scale （ VAS ） score and incidence of postoperative complications were compared between the two groups .After 1 year of follow-up, the recurrence rate of the two groups was counted .Results There was no insignificant difference between the two groups in the operation time or the number of lymph node dissection （ P〉0.05 ） .Compared with control group , the amount of bleeding in observation group was less , the length of the incision was shorter , and the time of hospitalization was shorter （ P〈0.05 ） .There was no significant difference between the two groups in CD3 ＋, CD4 ＋and CD4 ＋/CD8 ＋before operation （ P〉0.05 ）;3 days after operation , CD3 ＋, CD4 ＋and CD4 ＋/CD8 ＋in the two groups were lower than those before operation （ P〈0.05 ） , but the CD3 ＋, CD4 ＋and CD4 ＋/CD8 ＋of observation group were higher than those of control group （ P〈0.05 ） .The＆nbsp;scores of VAS on 1 day, 3 days and 7 days after operation were lower in observation group than those in control group （P〈0.05）.The incidence of postoperative complications of observation group （6.45％） was lower than that of control group （ 28.13％） , P〈0.05 .One year after operation , there was no significant difference in the recurrence rate between observation group （ 3.23％） and control group （9.38％） , P〉0.05.Conclusions Video-assisted thoracoscopic lobectomy in the treatment of early NSCC can achieve the same dissection outcome as traditional thoracotomy , but with minimal invasion , little impair on immune function , and little pain.It can effectively reduce the incidence of postoperative complications.