胸腔镜与开胸肺叶切除术对早期肺癌患者炎症因子水平、免疫功能及心肺功能的影响

Effects of thoracoscopic and open pulmonary lobectomy on early-stage lung cancer patients′inflammatory factors levels,immune function,and cardiopulmonary function

目的对比分析胸腔镜肺叶切除术与传统开胸肺叶切除术对早期肺癌患者炎症因子水平、免疫功能及心肺功能的影响。方法选取114例早期肺癌患者为研究对象,根据治疗方案将其分为研究组(57例)和对照组(57例)。研究组行胸腔镜肺叶切除术治疗,对照组行常规开胸手术治疗。对比两组患者的手术相关指标(切口长度、淋巴结清扫数目、手术时间、术中出血量、术后引流量)、术后VAS评分,以及手术前后的免疫功能、炎症因子水平、心肺功能。结果与对照组相比,研究组患者的切口长度、手术时间更短,淋巴结清扫数目更多,术中出血量和术后引流量更少(均P<0.05);研究组术后1 d、3 d、7 d的VAS评分均较对照组降低(均P<0.05);术后两组患者的CD4^(+)T淋巴细胞水平、CD8^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)T淋巴细胞水平比值均较术前降低,且研究组上述指标水平高于对照组(均P<0.05);术后两组患者的肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)水平均较术前升高,且研究组上述指标水平低于对照组(均P<0.05);术后两组患者的左室射血分数(LVEF)较术前升高,左室收缩末期容积指数(LVESVI)、左室舒张末期内径(LVEDD)、左室舒张末期容积指数(LVEDVI)、二尖瓣口舒张早期和收缩早期最大血流速度比值(E/A)均较术前下降,与对照组相比,研究组术后LVEF更高,LVESVI、LVEDD、LVEDVI、E/A更低(均P<0.05);术后两组的用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)/FVC均较术前低,且研究组上述指标水平高于对照组(均P<0.05)。结论与传统开胸肺叶切除术相比,采用胸腔镜肺叶切除术治疗早期肺癌的效果显著,淋巴结清扫效果更优,且该术式可缩短手术时间,减少术中出血量和术后引流量,减轻机体炎症反应,对免疫功能、心肺功能的影响较小,患者术后疼痛轻,值得临床应用推广。

Objective To compare and analyze the effects of thoracoscopic pulmonary lobectomy and traditional open pulmonary lobectomy on the inflammatory factors levels,immune function,and cardiopulmonary function in early-stage lung cancer patients.Methods A total of 114 early-stage lung cancer patients were selected as research subjects,and they were divided into study group(n=57)and control group(n=57)according to the treatment plan.The study group was treated with thoracoscopic pulmonary lobectomy,while the control group was treated with traditional open pulmonary lobectomy.The following indices were compared between the two groups of patients,including operation-related indices(incision length,number of dissected lymph nodes,operation time,intraoperative blood loss,and postoperative drainage),postoperative VAS scores,and the preoperative and postoperative immune function,inflammatory factors levels,and cardiopulmonary function.Results Compared with the control group,patients in the study group had shorter incision length and operation time,more dissected lymph nodes,and less intraoperative blood loss and postoperative drainage(all P<0.05).The VAS scores of the study group 1 day,3 days,and 7 days after the operation were lower than those of the control group(all P<0.05).After the operation,the CD4^(+)T lymphocytes levels,CD8^(+)T lymphocytes levels,and the ratio of CD4^(+)/CD8^(+)T lymphocyte levels in the two groups of patients were lower than those before the operation,and the levels of the above indices of the study group were higher than those of the control group(all P<0.05).The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),and C-reactive protein(CRP)of the two groups of patients after the operation were higher than those before the operation,and the levels of the above indices in the study group were lower than those in the control group(all P<0.05).After the operation,the left ventricular ejection fraction(LVEF)of the two groups of patients was higher,the left ventricular end-systolic volume index(LVESVI),left ventricular end-diastolic dimension(LVEDD),left ventricular end-diastolic volume index(LVEDVI),and the ratio of early-diastolic mitral maximal blood flow velocity to the early-systolic mitral maximal blood flow velocity(E/A)were lower than those before the operation.Compared with the control group,the study group had higher LVEF and lower LVESVI,LVEDD,LVEDVI,and E/A after the operation(all P<0.05).The forced vital capacity(FVC),forced expiratory volume in 1 second(FEV_(1)),and FEV_(1)/FVC in the two groups after the operation were lower than those before the operation,and the above indices in the study group were higher than those in the control group(all P<0.05).Conclusion Compared with traditional open pulmonary lobectomy,thoracoscopic pulmonary lobectomy has a significant effect in the treatment of early-stage lung cancer and in lymph node dissection.The operation can shorten the operation time,reduce the intraoperative blood loss and postoperative drainage,and reduce the body′s inflammatory response,with little impact on the immune function and cardiopulmonary function,and causing mild postoperative pain in the patients,which is worthy of clinical application and promotion.