3D打印技术辅助SP-VATS治疗与肺癌患者疗效的关系研究

Relationship between three-dimensional printing technology assisted SP-VATS and curative effect of lung cancer patients

目的分析三维(3D)打印技术辅助单操作孔电视胸腔镜手术(SP-VATS)治疗在肺癌中的应用及其与患者治疗临床疗效关系。方法选择2016年1月至2017年6月在武汉市普仁医院收治的70例肺癌患者,其中男性39例,女性31例;年龄44~73岁,平均年龄61.10岁;吸烟史24例;肿瘤直径1.20~5.21 mm,平均直径2.40 mm;TNM分期Ⅰ期59例,Ⅱ期3例,Ⅲa期8例;肿瘤病灶左侧43例,右侧27例。依照随机信封法分为观察组及对照组,每组35例。观察组男性19例,女性16例;年龄45~72岁,平均年龄60.87岁;吸烟史13例;肿瘤直径(2.37±0.93) mm;TNM分期Ⅰ期29例,Ⅱ期2例,Ⅲa期4例;肿瘤位于左侧21例,右侧14例。对照组男性20例,女性15例;年龄44~73岁,平均年龄61.32岁;吸烟史11例;肿瘤直径(2.42±0.89)mm;TNM分期Ⅰ期30例,Ⅱ期1例,Ⅲa期4例;肿瘤位于左侧22例,右侧13例。对照组采用单纯SP-VATS治疗,观察组采用3D打印技术辅助SP-VATS治疗,Ⅲa期加系统淋巴结清扫;记录患者治疗基本情况,术后第1、3、5、7天采用视觉模拟量表(VAS)评分对患者疼痛情况进行调查;采用卡氏(KPS)评分对患者生存质量进行调查;随访18个月记录患者并发症及生存情况。结果观察组术中出血量、手术时间、术中引流时间、术后引流量及镇痛药使用时间均明显低于对照组[(117.84±37.93) mL vs (168.95±32.19) mL,(141.29±10.18) min vs (154.85±12.37) min,(5.97±1.84) d vs (7.42±1.89) d,(578.38±73.82) mL vs (928.94±81.16) mL,(2.23±0.38) d vs (3.57±0.67) d](P <0.05);术后第1天和第3天,观察组VAS评分明显低于对照组[第1天:(73.05±10.29)分vs (85.97±11.32)分;第3天:(62.38±8.49)分vs (74.95±9.21)分](P <0.05);观察组术后KPS评分稳定改善率明显高于对照组(97.14%vs 85.71%;P <0.05);观察组术后不良反应发生率明显低于对照组(8.57%vs 25.71%;P <0.05)。结论采用3D打印技术辅助SP-VATS对肺癌患者治疗后,可有效改善治疗临床疗效。

Objective To analyze application of three-dimensional printing technology assisted single port video assisted thoracoscopic surgery(SP-VATS) in patient with lung cancer and its relationship with clinical efficacy. Methods From January2016 to June 2017, a total of 70 lung cancer patients were enrolled, which included 39 males and 31 females, aged 44-73 years old with mean age of 61.10 years old, 24 cases with smoking history;tumor diameter was 1.20-5.21 mm with mean di-ameter of 2.40 mm;59 cases with TNM stage Ⅰ, 3 cases with stage Ⅱ and 8 cases with Ⅲa. There were 43 tumor lesions located on the left and 27 on the right. According to random envelope method, all of them were divided into observation group and control group. The observation group(n = 35) included 19 males and 16 females, aged 45-72 years old with mean age of60.87 years old, 13 cases with smoking history;tumor diameter was(2.37 ± 0.93) mm;29 cases with TNM stageⅠ, 2 cases with stage Ⅱ and 4 cases with stage Ⅲa. There were 21 tumor lesions located on the left and 14 on the right. The control group(n =35) had 20 males and 15 females, aged 44-73 years old with mean age of 61.32 years old;11 cases with smoking history;tumor diameter was(2.42 ± 0.89) mm;30 cases with TNM stage Ⅰ, 1 case of stage Ⅱ and 4 cases with stage Ⅲa;tumor lesions of 22 were located on the left and 13 on the right. The control group performed simple SP-VATS, and observation group performed 3 D printing technology assisted SP-VATS, which combined with lymph node dissection in stage Ⅲa;The basic treatment condition was recorded, and visual analog scale(VAS) score was used to evaluate pain 1-, 3-, 5-and 7-day post opera-tion. The Karnofsky(KPS) score was used to analyze quality of life. The patients were follow-up for 18 months, and complica-tions and survival of patients were recorded. Results The intraoperative blood volume, operation time, intraoperative drainage time, postoperative drainage volume and analgesic time of observation group were significantly lower than those of control group[(117.84 ± 37.93) mL vs(168.95 ± 32.19) mL,(141.29 ± 10.18) minutes vs(154.85 ± 12.37) minutes,(5.97 ± 1.84) days vs(7.42 ± 1.89) days,(578.38 ± 73.82) mL vs(928.94 ± 81.16) mL,(2.23 ± 0.38) days vs(3.57 ± 0.67) days](P < 0.05). VAS score at 1-day and 3-day after operation of observation group were significantly lower than those of control group[1-day:(73.05 ±10.29) scores vs(85.97 ± 11.32) scores;3-day:(62.38 ± 8.49) scores vs(74.95 ± 9.21) scores](P < 0.05). The stable improvement rate of postoperative KPS score in observation group was significantly higher than that in control group(97.14 % vs 85.71 %;P < 0.05). The incidence of postoperative adverse reactions in observation group was significantly lower than that of control group(8.57 % vs 25.71 %;P < 0.05). Conclusion It is demonstrated that 3 D printing technology assisted SP-VATS for patients with lung cancer could effectively improve the clinical efficacy of treatment.