单孔胸腔镜肺癌根治术中迷走神经保护对手术效果及术后并发症的影响

The effect of protection of the vagus nerve on reduction of the incidence of complications after single-hole thoracoscopic radical resection of lung cancer

目的探讨在单孔胸腔镜行非小细胞肺癌(NSCLC)根治术中实施迷走神经保护对手术效果及术后并发症的影响。方法选取2021年1月至8月在安徽医科大学第一附属医院胸外科行单孔胸腔镜肺癌根治术治疗的84例NSCLC患者,其中54例在术中进行了迷走神经保护(研究组),30例未因多种原因无法行迷走神经保护(对照组)。比较两组手术时间、术中出血量、淋巴结清扫数、术后住院时间以及胃肠胀气、心律失常、肺部感染、排痰困难等术后并发症发生率。结果研究组与对照组手术时间[(92.17±26.16)min vs.(86.00±24.85)min,P=0.295]、术中出血量[(57.30±11.52)ml vs.(61.67±12.66)ml,P=0.111]、淋巴结清扫组数[(5.27±1.47)组vs.(5.53±1.47)组,P=0.448]差异无统计学意义。研究组术后住院时间短于对照组[(3.79±0.68)d vs.(5.36±0.96)d,P<0.001],研究组术后胃肠胀气发生率(12.96%vs.63.33%,P<0.001)、心律失常发生率(1.85%vs.26.67%,P<0.001)、肺部感染发生率(3.70%vs.20.00%,P=0.014)、排痰困难发生率(5.56%vs.23.33%,P=0.015)均低于对照组,差异有统计学意义。结论单孔胸腔镜下行NSCLC根治术中实施迷走神经保护是安全有效的,可保证手术的根治程度,同时降低术后并发症发生率。

Objective To evaluate the effect of protection of vagus nerve in single-hole thoracoscopic radical resection of lung cancer on the reduction of the incidence of complications.Methods From January 2021 to July 2021,84 patients with non-small cell lung cancer(NSCLC)who were hospitalized in the Department of Thoracic Surgery of the First Affiliated Hospital of Anhui Medical University underwent single-hole thoracoscopic radical resection,they were divided into vagus nerve protection group(study group,n=54)and the non-vagus nerve protection group(control group,n=30),they underwent single-hole thoracoscopic radical resection of lung cancer plus vagus nerve protection or simple single-hole thoracoscopic radical resection alone.The operation time,intraoperative bleeding,dissection of lymph nodes,postoperative hospital time and postoperative complications were recorded.Results There was no statistically significant difference between the two groups in operation time[(92.17±26.16)min vs.(86.00±24.85)min,P=0.295],intraoperative bleeding[(57.30±11.52)ml vs.(61.67±12.66)ml,P=0.111],number of lymph nodes[(5.27±1.47)group vs.(5.53±1.47)group,P=0.448].However,the postoperative hospital time in the study group was significantly shorter than that in the control group[(3.79±0.68)days vs.(5.36±0.96)days,P<0.001].The incidence of postoperative flatulence(12.96%vs.63.33%,P<0.001),arrhythmia(1.85%vs.26.67%,P<0.001),lung infection(3.70%vs.20.00%,P=0.014),sputum dysfunction(5.56%vs.23.33%,P=0.015)in the study group was lower than the control group,and the difference was statistically significant.Conclusions The protection of the vagus nerve is safe,it can guarantee the radical degree of the operation and reduce the incidence of postoperative complications.