胸腔镜肺切除术的临床应用及对患者肺功能的影响

Clinical Application of Thoracoscopic Pneumonectomy and Its Effect on Pulmonary Function

目的:探讨胸腔镜肺切除术的临床应用及对患者肺功能的影响。方法:回顾性分析2014年5月-2018年5月本院收治的需择期进行手术的肺癌患者200例的临床资料。根据手术方案不同分为研究组和对照组,各100例。研究组行胸腔镜肺叶或肺段切除术,对照组行传统开胸肺叶或肺段切除术。比较两组手术指标、手术前后炎症因子(IL-6、CRP、TNF-α)、肺功能指标(FEV_1、FEV_1%pred、FEV_1/FVC%、6MWT)。结果:两组手术时间、淋巴清扫数目比较,差异均无统计学意义(P>0.05),研究组术中出血量、住院时间以及并发症发生率均低于对照组(P<0.05);术后,研究组FEV_1、FEV_1%pred、FEV_1/FVC%以及6MWT均优于对照组,差异均有统计学意义(P<0.05);术后,研究组IL-6、CRP、TNF-α水平均低于对照组(P<0.05)。结论:相比于传统开胸肺叶或肺段切除术,胸腔镜下手术效果更佳,不仅可以减少术中出血量,亦能够降低患者炎症水平,提高肺功能,从而减少并发症发生,缩短患者住院时间,临床上应进一步推广应用。

Objective:To explore the clinical application of thoracoscopic pneumonectomy and its effect on pulmonary function.Method:The clinical data of 200 patients with lung cancer who needed selective surgery in our hospital from May 2014 to May 2018 were retrospectively analyzed.According to the different surgical schemes,they were divided into study group and control group,100 cases in each group.The study group underwent thoracoscopic lobectomy or segmentectomy,and control group underwent conventional thoracotomy for lobectomy or segmentectomy.The indexes of operation,inflammatory factors(IL-6,CRP,TNF-α),lung function(FEV1,FEV1%pred,FEV1/FVC%,6 MWT)before and after operation between two groups were compared.Result:The operation time and the number of lymph node dissection in two groups were compared,the differences were not statistically significant(P>0.05),the amount of bleeding,hospitalization time and the incidence of complications in study group were lower than those of control group(P<0.05).After operation,the FEV1,FEV1%pred,FEV1/FVC% and 6 MWT in study group were better than those of control group,the differences were statistically significant(P<0.05).After operation,the levels of IL-6,CRP and TNF-α in study group were lower than those of control group(P<0.05).Conclusion:Compared with traditional thoracotomy for lobectomy or segmentectomy,thoracoscopic pulmonary lobectomy is more effective,it can not only reduce intraoperative bleeding,but also reduce the level of inflammation and improve pulmonary function,so as to reduce complications and shorten hospitalization time,it should be further popularized and applied in clinic.