两种入路单孔胸腔镜下肺叶切除术对非小细胞肺癌病人术后康复进程、肺功能及内环境指标的影响

Comparison of the effects of single-port thoracoscopic lobectomy under two approaches on postoperative rehabilitation process, pulmonary function and internal environment indexes of non-small cell lung cancer

目的 观察两种入路(经剑突下、经肋间)下单孔胸腔镜下肺叶切除术对非小细胞肺癌病人术后康复进程、肺功能及内环境指标的影响。方法 非小细胞肺癌病人82例,依据手术入路不同分为两组,均行单孔胸腔镜下肺叶切除术。经剑突下组43例,行经剑突下手术;经肋间组39例,行经肋间下手术。比较两组手术情况、并发症情况、术后疼痛评分(VAS)、术后1年生存率、手术前后机体内环境指标、肺功能指标。结果 两组淋巴结清扫数目比较,差异无统计学意义(P>0.05),经剑突下组手术时间为(151.72±28.04)分钟,经肋间组为(137.35±24.72)分钟,经剑突下组住院、置管及下床活动时间分别为(5.02±0.84)天、(3.91±1.47)天和(10.04±1.83)天,经肋间组分别为(5.53±0.96)天、(4.86±1.72)天、(11.85±2.06)天,两组比较差异有统计学意义(P<0.05);经剑突下组术中出血量、术后6小时、1天、2天、3天的VAS评分均低于肋间组,两组比较差异有统计学意义(P<0.05);经剑突下组术后1天、3天血清C反应蛋白(CRP)、白细胞介素(IL)-6、肌酸激酶(CK)水平分别为(10.52±1.83)mg/L、(8.36±1.28)mg/L,(121.87±15.74)pg/ml、(106.90±11.82)pg/ml,(247.80±26.57)U/L、(219.74±30.09)U/L,经肋间组分别为(15.76±2.48)mg/L、(10.75±1.59)mg/L,(169.20±18.16)pg/ml、(132.62±15.71)pg/ml,(336.27±41.58)U/L、(292.84±34.29)U/L,两组比较差异有统计学意义(P<0.05);两组术后1个月最大自主通气量(MVV)、第1秒用力呼气流量(FEV1)/用力肺活量(FVC)水平均较术前降低,差异有统计学意义(P<0.05),但组间比较,差异无统计学意义(P>0.05);两组术后并发症发生率、术后1年生存率比较,差异无统计学意义(P>0.05)。结论 与经肋间入路手术比较,经剑突下单孔胸腔镜下肺叶切除术治疗非小细胞肺癌不仅疗效肯定,且可减少手术创伤,减轻术后疼痛感,稳定机体内环境,促进术后恢复。

Objective To observe and compare the effects of single-port thoracoscopic lobectomy under two approaches(transxiphoid and intercostal) on postoperative rehabilitation progress, pulmonary function and internal environment indexes of non-small cell lung cancer.Methods 82 patients with non-small cell lung cancer in Civil Aviation General Hospital were divided into two groups according to different surgical approaches.All patients underwent single hole thoracoscopic lobectomy.43 patients in the transxiphoid group underwent transxiphoid surgery and 39 patients in the intercostal group underwent subcostal surgery.The operation conditions, complications, postoperative pain score(VAS),1-year survival rate after operation, internal environment indexes and pulmonary function indexes before and after operation were compared between the two groups.Results There was no difference in the number of lymph nodes dissected between the two groups(P>0.05).The operation time in the transxiphoid group[(151.72±28.04)min] was longer than that in the intercostal group[(137.35±24.72)min],but the hospitalization, catheter placement and ambulation time were(5.02±0.84) d,(3.91±1.47) d and(10.04±1.83) d, respectively, which were shorter than those in the transcostal group[(5.53±0.96)d,(4.86±1.72)d,(11.85±2.06)d(P<0.05)].The intraoperative blood loss, VAS score at 6 h, 1 d, 2 d, and 3 d after operation in the transxiphoid group were lower than those in the intercostal group(P<0.05).The levels of serum C-reactive protein(CRP),interleukin-6(IL-6),and creatine kinase(CK) in the xiphoid group were(10.52±1.83) mg/L,(8.36 ±1.28) mg/L,(121.87±15.74) pg/ml,(106.90±11.82) pg/ml,(247.80±26.57) U/L,(219.74±30.09) U/L,all lower than the intercostal group(15.76±2.48)mg/L,(10.75±1.59)mg/L,(169.20±18.16)pg/ml,(132.62±15.71)pg/ml,(336.27±41.58)U/L,(292.84±34.29)U/L(P<0.05).The levels of maximum spontaneous ventilation(MVV) and forced expiratory flow in 1 second(FEV1)/forced vital capacity(FVC) in the two groups at 1 month after operation were lower than those before operation(P<0.05),but there was no difference between the groups(P>0.05).There was no difference in postoperative complication rate and 1-year survival rate between the two groups(P>0.05).Conclusion Compared with the transcostal approach, Subxiphoid single-port thoracoscopic lobectomy in the treatment of non-small cell lung cancer is not only effective, but also can reduce surgical trauma, relieve postoperative pain, stabilize the internal environment of the body, and promote postoperative recovery.