全胸腔镜肺叶切除和开胸肺叶切除治疗NSCLS患者疗效及预后分析

Curative Effect and Prognosis of Patients with NSCLS Treated with Total Thoracoscopic Lobectomy and Open Lobectomy

目的探讨全胸腔镜肺叶切除和开胸肺叶切除治疗非小细胞肺癌(NSCLS)患者疗效及预后的影响。方法106例NSCLS患者,依据手术方案不同分为胸腔镜组(全胸腔镜肺叶切除治疗,n=57)、开胸组(开胸肺叶切除治疗,n=49),比较两组手术有关指标、实验室检测指标[白介素-6(IL-6),C反应蛋白(CRP)/肿瘤坏死因子-α(TNF-α)]、随访总生存率及并发症发生情况。结果与开胸组比较,胸腔镜组手术操作时间、住院时间明显短、术中总出血量、术后24 h NRS评分明显小,差异显著(P<0.05),两组淋巴结清扫数量比较差异不显著(P>0.05);与术前比较,术后3、5天两组IL-6、CRP、TNF-α明显升高,但胸腔镜组明显低于开胸组(P<0.05);胸腔镜组术后1、2年OS(85.96%、68.42%)较开胸组(75.51%、53.06%)略高,但差异不显著(P>0.05);胸腔镜组并发症总发生率明显低于开胸组(P<0.05)。结论与开胸肺叶切除术相比较,全胸腔镜肺叶切除术治疗NSCLS的近期疗效相当,但后者在缩短手术时间、住院时间、减轻创伤、术后疼痛、炎性反应及免疫抑制等方面有明显优势,此外全胸腔镜肺叶切除术或可提高NSCLS患者的预后生存率,且安全性好。

Objective To investigate the curative effect of total thoracoscopic lobectomy and open lobectomy on patients with non-small cell lung cancer(NSCLS)and the influence on prognosis.Methods 106 patients with NSCLS were divided into the thoracoscopic group(total thoracoscopic lobectomy,n=57)and the open group(open lobectomy,n=49)according to different surgical methods.The surgery related indicators,laboratory test indicators[interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)],follow-up overall survival(OS)rate and incidence of complications were compared between the 2 groups.Results The surgical operation time and hospitalization time of the thoracoscopic group were significantly shorter than those of the open group.The total intraoperative blood loss and the NRS score at 24 hours after surgery were significantly less/lower than those of the open group(P<0.05).There was no significant difference in the number of lymph nodes removed between the 2 groups(P>0.05).The IL-6,CRP and TNF-αin both groups were significantly increased at 3 and 5 days after surgery,but they were obviously lower in the thoracoscopic group than the open group(P<0.05).The postoperative 1-year and 2-year OS rates of the thoracoscopic group(85.96%and 68.42%)were slightly higher than those of the open group(75.51%and 53.06%)(P>0.05).The total incidence of complications in the thoracoscopic group was significantly lower than that in the open group(P<0.05).Conclusion The short-term curative effect of open lobectomy is similar to that of total thoracoscopic lobectomy in the treatment of NSCLS.However,the latter has more advantages in shortening surgical time and hospital stay,reducing trauma,postoperative pain,inflammatory response and immunosuppression.Besides,total thoracoscopic lobectomy may improve the survival rate of patients with NSCLS,with safety.