肺叶切除术与肺段切除术对直径≤2cm早期非小细胞肺癌患者肺通气功能指标及中远期预后的影响

Effects of Lobectomy and Segmental Pneumonectomy on Pulmonary Ventilation Function and Medium and Long-Term Prognosis in Patients with Early Non-Small Cell Lung Cancer with Diameter≤2cm

目的:观察肺段切除术与肺叶切除术对直径≤2 cm早期非小细胞肺癌(NSCLC)患者的影响。方法:收集2016年2月~2017年2月在青岛市中心医院接受肺叶切除术或肺段切除术的直径≤2 cm早期NSCLC患者的病例资料,共计110例,按照手术方式的不同分为A组(肺叶切除术,51例)和B组(肺段切除术,59例)。对比两组围术期指标及并发症发生率、肺通气功能指标、免疫功能指标及中远期预后。结果:两组术中清扫淋巴结数目、并发症发生率组间对比无统计学差异(P>0.05)。B组的手术时间长于A组,住院费用高于A组,术中出血量、术后引流量少于A组,术后住院时间短于A组(P<0.05)。两组术后6个月用力肺活量(FVC)、一秒用力呼气容积(FEV1)、最大呼气流速峰值(PEF)、每分钟最大通气量(MVV)、每分钟最大通气量(TLCO)均下降,但B组高于A组(P<0.05)。两组术后7 d CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均下降,但B组高于A组(P<0.05),两组术后7 d CD8^(+)升高,但B组低于A组(P<0.05)。两组3年生存率、5年生存率及复发率组间对比无显著差异(P>0.05)。结论:肺段切除术可更好的保护直径≤2 cm早期NSCLC患者免疫功能和肺通气功能,但其与肺叶切除术中远期预后效果相当。

Objective:To observe the effects of segmental pneumonectomy and lobectomy on patients with early non-small cell lung cancer(NSCLC)with diameter≤2 cm.Methods:The case data of 110 patients with early NSCLC with diameter≤2 cm who underwent lobectomy or segmental resection in Qingdao Central Hospital from February 2016 to February 2017 were collected.They were divided into group A(lobectomy,51 cases)and group B(segmental pneumonectomy,59 cases)according to different surgical methods.The perioperative indexes,complication rate,pulmonary ventilation function indexes,immune function indexes and medium and long-term prognosis were compared between the two groups.Results:There were no significant differences in the number of lymph nodes and the incidence of complications between the two groups(P>0.05).The operation time of group B was longer than that of group A,the hospitalization cost was higher than that of group A,the amount of intraoperative bleeding and postoperative drainage were less than that of group A,and the postoperative hospitalization time was shorter than that of group A(P<0.05).The forced vital capacity(FVC),forced expiratory volume in one second(FEV1),peak expiratory flow rate(PEF),maximum ventilation per minute(MVV)and maximum ventilation per minute(TLCO)in the two groups at 6 months after operation decreased,but the group B was higher than the group A(P<0.05).CD3+,CD4^(+),CD4^(+)/CD8^(+)in two groups at 7 d after operation decreased,but group B was higher than group A(P<0.05).CD8^(+)in two groups at 7 d after operation increased,but group B was lower than group A(P<0.05).There was no significant difference in 3-year survival rate,5-year survival rate and recurrence rate between the two groups(P>0.05).Conclusion:Segmental pneumonectomy can better protect the immune function and pulmonary ventilation function of patients with early NSCLC with diameter≤2 cm,but its prognosis effect is similar to that of lobectomy in the medium and long-term.