胸腔镜下肺叶切除与肺段切除对肺癌患者通气功能及免疫功能的影响

Effects of Thoracoscopic Lobectomy and Segmentectomy on Ventilation Function and Immune Function of Patients with Lung Cancer

目的分析胸腔镜下肺叶切除与肺段切除对肺癌患者通气功能及免疫功能的影响。方法收集2018年1月至2019年12月麻城市人民医院胸外科收治的101例肺癌患者的病例资料进行回顾性分析,按照治疗方法不同分为对照组(45例)和观察组(56例),其中对照组采用胸腔镜下肺叶切除术,观察组采用胸腔镜下肺段切除术。观察并比较两组患者的围手术期指标(术中出血量、引流量、引流时间、住院时间及住院费用),通气功能指标[用力肺活量占预计值百分比(FVC%pred)、第一秒用力呼气量占预计值百分比(FEV 1%pred)及最大通气量占预计值百分比(MVV%pred)],淋巴细胞[CD3+、自然杀伤细胞(NK细胞)、CD4+/CD8+]及免疫球蛋白(Ig)[(IgA、IgG、IgM)]水平。结果观察组的术中出血量、引流量均少于对照组[(70±15)mL比(160±29)mL,(558±50)mL比(990±150)mL],引流时间和住院时间均短于对照组[(3.2±0.7)d比(4.6±1.4)d,(9.2±2.2)d比(13.2±3.8)d],住院费用高于对照组[(47856±2564)元比(45236±2315)元](P<0.01)。FVC%pred、FEV 1%pred、MVV%pred的时点间与组间存在交互作用(P<0.01),两组患者术后半年的FVC%pred、FEV 1%pred、MVV%pred均降低,但观察组高于对照组(P<0.01)。CD3+、NK细胞、CD4+/CD8+、IgG、IgA、IgM水平的时点间与组间存在交互作用(P<0.05),术后3 d、1周,观察组的CD3+、NK细胞、CD4+/CD8+、IgA、IgG水平均高于对照组,IgM水平低于对照组(P<0.05)。两组患者肺漏气、肺部感染、肺不张、脓胸、支气管胸膜瘘的发生率比较差异无统计学意义(P>0.05)。结论与肺叶切除术相比,肺癌患者接受胸腔镜下肺段切除术治疗,虽然在一定程度上增加了患者医疗负担,但患者术中出血量、引流量均减少,术后免疫功能受影响较小,通气功能更好更快恢复,住院时间大大缩短。

Objective To analyze the effects of thoracoscopic lobectomy and segmentectomy on ventilation and immune function of patients with lung cancer.Methods The data of 101 patients with lung cancer admitted to the Department of Thoracic Surgery of Macheng People′s Hospital from Jan.2018 to Dec.2019 were retrospectively analyzed,according to different treatment methods,they were divided into a control group(45 cases)and an observation group(56 cases).The control group was given thoracoscopic lobectomy,and the observation group was given thoracoscopic segmentectomy.The perioperative indexes(intraoperative bleeding,drainage,duration of drainage,length of hospital stay and hospital costs),ventilatory function indexes[forced vital capacity as a percentage of expected value(FVC%pred),forced expiratory volume in the first second percentage to expected value(FEV 1%pred)and maximal ventilatory volume percentage to expected value(MVV%pred)],lymphocytes[CD3+,natural killer cells(NK cells),CD4+/CD8+]and immunoglobulin(Ig)(IgA,IgG,IgM)levels of the patients in both groups were observed and compared.Results The intraoperative bleeding and drainage volume of the observation group were less than those of the control group[(70±15)mL vs(160±29)mL,(558±50)mL vs(990±150)mL],the drainage time and hospitalization time were shorter than those of the control group[(3.2±0.7)d vs(4.6±1.4)d,(9.2±2.2)d vs(13.2±3.8)d],and the hospitalization expense was higher than that of the control group[(47856±2564)yuan vs(45236±2315)yuan](P<0.01).There was interaction between the time points and groups in FVC%pred,FEV 1%pred and MVV%pred(P<0.01);half a year after operation,FVC%pred,FEV 1%pred and MVV%pred of both groups were decreased,but the observation group was higher than the control group(P<0.01);there was interaction between the time points and groups in CD3+,NK cells,CD4+/CD8+,IgG,IgA and IgM levels(P<0.05);3 days,1 week after surgery,the levels of CD3+,NK cells,CD4+/CD8+,IgA and IgG in the observation group were higher than those in the control group,and the IgM level was lower than that in the control group(P<0.05).The incidence of complications such as lung leakage,pulmonary infection,atelectasis,empyema,bronchopleural fistula of the two groups had no statistically significant difference(P>0.05).Conclusion Compared with lobectomy,thoracoscopic segmentectomy increases the medical burden of the patients with lung cancer to a certain extent,but it reduces the amount of bleeding and drainage volume during the operation,has less impact on the postoperative immune function,and has faster and better ventilation function improvement,thereby shortens the hospital stay greatly.