电视胸腔镜解剖性肺段切除术与肺叶切除术治疗肺部结节疗效及安全性

Efficacy and safety of video-assisted thoracoscopic anatomic segmental resection and lobectomy in the treatment of pulmonary nodules

目的探讨电视胸腔镜下解剖性肺段切除术与肺叶切除术治疗肺部结节的疗效及安全性。方法选择2015年10月～2017年10月在川北医学院附属医院和成都市第五人民医院接受诊治的112例肺部结节患者为研究对象,根据手术方法不同分成对照组64例和研究组48例。对照组接受电视胸腔镜下肺叶切除术治疗,研究组接受电视胸腔镜下解剖性肺段切除术治疗。对比两组患者的手术时间、术中出血量、术后引流时间、术后引流量、术后住院时间、术后疼痛程度、肺功能变化及并发症发生率。结果研究组患者的手术时间、术中出血量、术后引流时间、术后引流量、术后住院时间均低于对照组,差异均有统计学意义(P<0.05);而术后第1、3、5d时的疼痛VAS评分与对照组相比,差异无统计学意义(P>0.05)。术后两组患者的肺功能指标FVC、FEV1、MVV水平均低于术前,但研究组高于对照组,差异均有统计学意义(P<0.05);两组术后并发症发生率对比,差异无统计学意义(P>0.05)。影像学结果显示,对照组肺组织结构正常,有少量炎性细胞浸润出现,无水肿;研究组患者肺组织结构炎性细胞浸润显著减少,出现较少的肺泡内出血,且毛细血管出现轻微扩张。结论电视胸腔镜下解剖性肺段切除术与肺叶切除术均能有效治疗肺部结节,且安全性高,但肺段切除术能对患者的肺功能进行更好的保留,利于患者术后恢复,故可参照患者的具体情况合理选择术式。

Objective To study the efficacy and safety of video-assisted thoracoscopic anatomical segmentectomy and lobectomy for pulmonary nodule and provide reference for clinical treatment.Methods 112 patients with lung nodules during the period from October 2015 to October 2017 were selected as the subjects of this study.The patients were divided into a control group of 64 patients and a study group of 48 patients according to different treatment methods.The patients in the control group were given video-assisted thoracoscopic lobectomy for treatment,and the patients in the study group underwent video-assisted thoracoscopic anatomic segmentectomy.The operative time,intraoperative blood loss,postoperative drainage time,postoperative drainage,postoperative hospital stay,postoperative pain,pulmonary function changes,and complication rate were compared between the two groups.Results The duration of surgery,intraoperative blood loss,postoperative drainage time,postoperative drainage volume and postoperative hospital stay in the study group were lower than that in the control group(P<0.05).The VAS scores of pain in the study group on the 1st,3rd,and 5th days after surgery were not statistically different from those of the control group(P>0.05).The postoperative FVC,FEV1,MVV levels in the two groups of patients were lower than that before surgery,but the study group was higher than the control group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups[4.2%(2/48)vs 4.7%(3/64)](P>0.05).The radiographic results showed that the control group had normal lung structure,a small amount of inflammatory cell infiltration,and no edema.The study group had significantly less inflammatory cell infiltration in the lung tissue,less intrabuccal hemorrhage,and slight expansion of the capillaries.Conclusion Both of anatomic segmentectomy and lobectomy under video-assisted thoracoscopic surgery can effectively treat pulmonary nodules and have high safety.However,segmental resection can better preserve the patients lung function,which is beneficial to the patient's postoperative Recovery.