电视胸腔镜肺叶切除术治疗pT1期非小细胞肺癌对淋巴结清扫、术后疼痛及生活质量的影响

Effect of Video-assisted Thoracoscopic Lobectomy on Lymph Node Dissection,Postoperative Pain and Quality of Life in Patients with pT1 Non-small Cell Lung Cancer

目的:探讨电视胸腔镜肺叶切除术治疗pT1期非小细胞肺癌(NSCLC)对淋巴结清扫、术后疼痛及生活质量的影响。方法:选择2017年10月-2020年12月本院收治的非小细胞肺癌患者80例,根据手术方式不同分为VATS组(n=50)与OPEN组(n=30),VATS组给予电视胸腔镜肺叶切除术,OPEN组给予开胸肺叶切除术。记录比较两组围手术期一般指标、淋巴结清扫情况、术后疼痛及生活质量情况。结果:与OPEN组比较,VATS组术中出血量少、引流管放置时间短、术后住院时间短,差异均有统计学意义(P<0.05)。两组手术时间、输血率及并发症发生率比较,差异均无统计学意义(P>0.05)。VATS组清扫淋巴结总数、肺门淋巴结及淋巴结站数均少于OPEN组(P<0.05),但两组清扫纵隔淋巴结数比较,差异无统计学意义(P>0.05)。VATS组术后1 d中重度疼痛率低于OPEN组(P<0.05),但两组术后2、4、8、12周中重度疼痛率比较,差异均无统计学意义(P>0.05)。VATS组术后2周整体生活质量与功能量表评分均优于OPEN组(P<0.05),但两组其他时间各评分比较,差异均无统计学意义(P>0.05)。结论:与开胸肺叶切除术相比,电视胸腔镜肺叶切除术治疗pT1期NSCLC围手术期情况更佳,可减少术后疼痛,改善生活质量,但术中淋巴结清扫效果较差。

Objective:To investigate the effect of video-assisted thoracoscopic lobectomy on lymph node dissection,postoperative pain and quality of life in patients with non-small cell lung cancer(NSCLC)in pT1 stage.Method:A total of 80 patients with NSCLC who treated in our hospital from October 2017 to December 2020 were divided into VATS group(n=50)and OPEN group(n=30)according to the operation mode.VATS group was given video-assisted thoracoscopic lobectomy and OPEN group was given open lobectomy.The general indexes of perioperative period,lymph node cleaning,pain and quality of life after operation were recorded and compared between two groups.Result:Compared with OPEN group,VATS group had less intraoperative bleeding,shorter drainage tube placement time and shorter postoperative hospital stay,the differences were statistically significant(P<0.05).There were no significant differences in operation time,blood transfusion rate and complication rate between two groups(P>0.05).The total number of lymph nodes,hilar lymph nodes and lymph nodes stations in VATS group were lower than those in OPEN group(P<0.05),and there was no significant difference in the number of mediastinal lymph nodes between two groups(P>0.05).The rate of moderate and severe pain in VATS group at 1 d after operation was lower than that in OPEN group(P<0.05),but there were no significant differences in the rates of moderate and severe pain between two groups at 2,4,8 and 12 weeks after operation(P>0.05).The overall quality of life and functional scale scores in VATS group at 2 weeks after operation were better than those in OPEN group(P<0.05),but there were no significant differences between two groups at other times(P>0.05).Conclusion:Compared with open lobectomy,video-assisted thoracoscopy surgery is better for the treatment of NSCLC in pT1 stage,which can achieve better perioperative period,reduce postoperative pain and improve the quality of life,but the effect of lymph node cleaning is poor.