两种手术方式治疗对非小细胞肺癌患者外周血肿瘤微转移指标的影响

Effects of two surgical methods on peripheral blood micro-metastasis indicators in patients with non-small cell lung cancer

目的比较胸腔镜肺叶切除术或肺段切除术患者外周血肿瘤微转移指标变化。方法非小细胞肺癌患者138例,根据手术方式分为肺叶组70例(胸腔镜肺叶切除术)和肺段组68例(胸腔镜肺段切除术);比较两组患者手术用时、术中出血量、胸腔引流量及术后住院时间,于术前3 d和术后半年时采用肺功能检查仪测定患者用力肺活量(FVC)和第1秒用力呼气容积(FEV_(1))同时取患者静脉血检测外周血肿瘤微转移指标(CK20mRNA、CK19mRNA、CEAmRNA及LunxmRNA)水平,记录术后半年内疾病复发和转移情况。结果肺段组术后住院时间短于肺叶组,胸腔引流量少于肺叶组,差异有统计学意义(P<0.05);术后半年时,两组患者FVC、FEV_(1)较手术前均有下降,且术后肺叶组低于肺段组,差异有统计学意义(P<0.05);术后半年时,肺叶组CK20mRNA、CK19mRNA、LunxmRNA表达水平低于肺段组,差异有统计学意义(P<0.05);随访半年内,肺叶组和肺段组总复发转移率分别为4.29%和11.76%,差异无统计学意义(χ^(2)=0.183,P=0.669)。结论胸腔镜肺叶切除术后外周血肿瘤微转移指标水平较胸腔镜肺段切除术更低,但胸腔镜肺段切除术后肺功能相对更好,胸腔引流量更少,术后住院时间相对更短。

Objective To investigate the changes of peripheral blood micro-metastasis indicators in non-small cell lung cancer(NSCLC)patients treated with thoracoscopic pulmonary lobectomy and segmentectomy.Methods One hundred and thirty-eight patients with NSCLC were divided into pulmonary lobe group(70 cases received thoracoscopic pulmonary lobectomy)and pulmonary segment group(68 cases received thoracoscopic segmentectomy).Comparing following indicators between both groups:operating time,intraoperative blood loss,chest drainage volume,and postoperative hospitalized time.Forced vital capacity(FVC)and forced expiratory volume in the first second(FEV_(1))were determined 3 days before operation and 6 months after operation.Meanwhile,the levels of peripheral blood micro-metastasis indicators(CK 20 mRNA,CK 19 mRNA,CEA mRNA,and Lunx mRNA)were detected.Recurrence and metastasis within 6 months after surgery were recorded.Results The postoperative hospital stay and chest drainage volume of pulmonary segment group were shorter/smaller than those of pulmonary lobe group,differences were statistically significant(P<0.05).6 months after operation,FVC and FEV_(1) decreased in both groups,and the two indicators in pulmonary lobe group were lower than those of pulmonary segment group,differences were statistically significant(P<0.05).The expression levels of CK 20 mRNA,CK 19 mRNA,and Lunx mRNA in pulmonary lobe group were lower than those in the pulmonary segment group,differences were statistically significant(P<0.05).The total recurrence and metastasis rate during 6 months of follow-up visit showed no statistically significant difference between the pulmonary lobe group and the pulmonary segment group(4.29%vs 11.76%;χ^(2)=0.183,P=0.669).Conclusion The levels of peripheral blood micro-metastasis indicators are lower after thoracoscopic pulmonary lobectomy than thoracoscopic pulmonary segmentectomy.However,thoracoscopic pulmonary segmentectomy achieves better postoperative lung function,the chest drainage volume is smaller,and postoperative hospital stay is shorter.