胸腔镜下肺癌根治术治疗老年NSCLC患者的疗效及对术后生存率的影响

Effect of Thoracoscopic Radical Resection of Lung Cancer on Elderly NSCLC Patients and Its Effect on Postoperative Survival Rate

目的评价胸腔镜下肺癌根治术治疗老年非小细胞肺癌(NSCLC)患者的疗效及对术后生存率的影响。方法选择2017年8月至2018年4月四川省第二中医医院收治的77例老年NSCLC患者为研究对象,根据治疗方法不同分为对照组(33例)和观察组(44例)。对照组采用开胸下肺癌根治术治疗,观察组采用胸腔镜下肺癌根治术治疗。比较两组患者围手术期相关指标,治疗前后的免疫指标[免疫球蛋白(Ig) A、IgM、IgG]、心肺功能指标[心率、最大通气量(MVV)、第一秒用力呼气量(FEV1)]、生存质量以及术后1年生存率。结果两组患者的淋巴结清扫个数、手术时间比较差异无统计学意义(P> 0. 05),观察组输血量、总引流量、术中出血量、住院时间少于对照组[(126±29) m L比(229±52) m L,(1 002±712) m L比(1 305±842) m L,(122±14) m L比(182±14) m L,(12. 6±3. 2) d比(21. 2±4. 2) d](P <0. 01)。术后7 d,两组IgA、IgM、IgG水平均高于术前(P <0. 05),观察组IgA、IgM、IgG高于对照组(P <0. 05)。术后7 d,两组心率高于术前,但观察组低于对照组(P <0. 05);两组MVV高于术前,观察组高于对照组(P <0. 05);两组FEV1低于术前,观察组FEV1低于对照组(P <0. 05)。观察组总并发症发生率低于对照组[4. 55%(2/44)比39. 39%(13/33)](P <0. 01)。术后1年,两组角色功能、情绪功能、社会功能、认知功能、躯体功能评分均高于术前,观察组高于对照组(P <0. 05)。随访1年观察组术后生存率高于对照组[88. 64%(39/44)比69. 70%(23/33)](P <0. 05)。结论与开胸下肺癌根治术相比,胸腔镜下肺癌根治术可有效改善患者的免疫功能与心肺功能,并进一步提高患者的生存质量。

Objective To evaluate the curative effect of thoracoscopic lung cancer radical surgery on elderly patients with non-small cell lung cancer(NSCLC)and its impact on the postoperative survival rate.Methods Seventy-seven elderly NSCLC patients admitted to the Second Traditional Chinese Medicine Hospital of Sichuan Province from Aug.2017 to Apr.2018 were included,and divided into a control group(33 cases)and an observation group(44 cases)according to the treatment method.The control group was treated with radical resection of lung cancer under thoracotomy,and the observation group was treated with radical resection of lung cancer under thoracoscope.The perioperative related indicators,the immune indicators before and after treatment[immunoglobulin(Ig)A,IgM,IgG],cardiopulmonary function indicators[heart rate,maximum ventilation(MVV),forced expiratory volume in the first second(FEV 1)],quality of life and 1-year follow-up survival rate of the two groups were compared.Results There was no significant difference in dissected lymph node number and operation time between the two groups(P>0.05).The blood transfusion volume,total drainage volume,intraoperative blood loss,and hospital stay of the observation group were less than those of the control group[(126±29)mL vs(229±52)mL,(1002±712)mL vs(1305±842)mL,(122±14)mL vs(182±14)mL,(12.6±3.2)d vs(21.2±4.2)d](P<0.01).At 7 d after operation,the levels of IgA,IgM and IgG in both groups were higher than those before surgery(P<0.05),and the IgA,IgM and IgG in the observation group were higher than those in the control group(P<0.05);the heart rate of both groups was higher than that before the operation,but the observation group was lower than the control group(P<0.05);the MVV of both groups was higher than that before the operation,and the observation group was higher than the control group(P<0.05);FEV 1 in both groups were ower than before operation,and the observation group was lower than the control group(P<0.05).The total complication rate of the observation group was lower than that of the control group[4.55%(2/44)vs 39.39%(13/33)](P<0.01).One year after surgery,the scores of role function,emotional function,social function,cognitive function,and physical function of the two groups were higher than those before the operation,and the observation group was higher than the control group(P<0.05).The 1-year postoperative survival rate of the observation group was higher than that of the control group[88.64%(39/44)vs 69.70%(23/33)](P<0.05).Conclusion Compared with radical thoracotomy for lung cancer,thoracoscopic radical surgery for lung cancer can effectively improve the immune function and cardiopulmonary function of the patients,and further improve the quality of life of the patients.