术前规划联合荧光胸腔镜精准肺段手术较传统胸腔镜肺段手术治疗早期肺腺癌近期结果比较

Comparison of Short-term Results of Preoperative Planning Combined with Fluorescence Video-assisted Thoracoscopic Precision Segmentectomy and Traditional Thoracoscopic Segmentectomy in the Treatment of Early Lung Adenocarcinoma

背景与目的肺癌的死亡率居所有恶性肿瘤的第一位,但对于早期肺腺癌患者不同的肺段切除术之间手术效果及对肺功能的影响研究较少。本研究旨在评估术前规划联合荧光胸腔镜精准肺段切除术与传统肺段切除术两种手术方式对早期肺腺癌患者肺功能保留程度和近期结果比较。方法前瞻性选取2020年1月1日-2020年10月31日于中国科学技术大学附属第一医院胸外科行胸腔镜肺段切除术患者60例,精准组30例,传统组30例,比较两组患者临床病理特征、围手术期资料和术后肺功能情况。结果精准组在手术时间上较传统组更短,差异有统计学意义(P<0.05)。术前肺功能精准组与传统组的用力肺活量(forced vital capacity, FVC)、一秒用力呼气容积(forced expiratory volume in one second, FEV1)和一氧化碳弥散量(carbon monoxide diffusing capacity, DLCO)分别为:(3.65±0.63)L vs (3.54±0.64)L、(2.72±0.50)L vs (2.54±0.48)L及(20.36±3.02)m L/mm Hg/min vs (19.16±3.18)m L/mm Hg/min,差异均无统计学意义(P>0.05)。术后1个月肺功能精准组与传统组的FVC、FEV1和DLCO分别为:(3.35±0.63)L vs (2.89±0.57)L、(2.39±0.54)L vs (2.09±0.48)L及(17.43±3.10)m L/mm Hg/min vs (15.78±2.86)m L/mm Hg/min,差异均有统计学意义(P<0.05);术后3个月肺功能精准组与传统组的FVC和DLCO分别为:(3.47±0.63)Lvs(3.20±0.56)L、(19.38±3.02)m L/mm Hg/min vs(17.79±3.21)m L/mm Hg/min,差异均无统计学意义(P>0.05)。结论术前规划联合荧光胸腔镜精准肺段切除术在段间平面识别、解剖血管及术后恢复等方便提供了优势,明显缩短了手术时间,使治疗更为精准。

Background and objective The mortality of lung cancer ranks first among all malignant tumors, but there are few studies on the effect of different segmentectomy on lung function in patients with early lung adenocarcinoma. The purpose of this study was to evaluate the degree of lung function preservation and short-term results of preoperative planning combined with fluorescence thoracoscopic precision segmentectomy and traditional segmentectomy in patients with early lung adenocarcinoma. Methods From January 1, 2020 to October 31, 2020, 60 patients underwent thoracoscopic segmentectomy in the Department of Thoracic Surgery of the First Affiliated Hospital of University of Science and Technology of China: 30 patients in precision segmentectomy group and 30 patients in traditional segmentectomy group. The clinicopathological features, perioperative data and postoperative pulmonary function of the two groups were compared. Results The operation time of the precision group was shorter than that of the traditional group, and the difference was statistically significant(P<0.05). The preoperative pulmonary function accuracy group and the traditional group in forced vital capacity(FVC), forced expiratory volume in one second(FEV1) and carbon monoxide diffusing capacity(DLCO) were(3.65±0.63) L vs(3.54±0.64) L,(2.72±0.50) L vs(2.54±0.48) L and(20.36±3.02) mL/mmHg/min vs(19.16±3.18) mL/mmHg/min, respectively. One month after operation, the FVC, FEV1 and DLCO of pulmonary function accuracy group and traditional group were(3.35±0.63) L vs(2.89±0.57) L,(2.39±0.54) L vs(2.09±0.48) L and(17.43±3.10) mL/mmHg/min vs(15.78±2.865) mL/mmHg/min, respectively. Three months after operation, the FVC and DLCO of pulmonary function accuracy group and traditional group were(3.47±0.63) L vs(3.20±0.56) L and(19.38±3.02) mL/mmHg/min vs(17.79±3.21) mL/mmHg/min, respectively. Conclusion Preoperative planning combined with fluorescence thoracoscopic precise segmentectomy provides advantages in intersegmental plane recognition, vascular anatomy and postoperative recovery, which significantly shortens the operation time and makes the treatment more accurate.