胸腔镜下肺楔形切除术与肺叶切除术治疗早期老年非小细胞肺癌的疗效比较

Clinical outcomes of thoracoscopic wedge resection versus lobectomy for early stage non small cell lung cancer

目的 探讨胸腔镜下肺楔形切除术与肺叶切除术对早期老年非小细胞肺癌(non small cell lung cancer,NSCLC)患者血清胰岛素(insulinum,INS)、皮质醇(cortisol,COR)、血管紧张素–Ⅱ(angiotensin Ⅱ,AT–Ⅱ)、去甲肾上腺素(norepinephrine,NE)、淀粉样蛋白A(serum amyloid A,SAA)的影响,并对其临床疗效进行比较。方法 选取2018年2月至2020年2月收治的早期老年NSCLC患者140例,采取随机数字表分法分为A组与B组,每组各70例。A组行胸腔镜下肺楔形切除术,B组行肺叶切除术,比较两组患者的手术时间、胸引流管置管、住院时间及术中失血量和引流量,于术前、术毕当天、术后1周检测两组患者的Ins、Cor、AT–Ⅱ、NE、SAA水平,并比较两组患者的并发症、局部复发率、远处转移率及生存率。结果 A组患者的手术时间、胸引流管置管和住院时间分别短于B组,A组患者的术中失血量及引流量分别少于B组,差异均有统计学意义(P<0.05)。A组患者术毕当天及术后1周INS、COR、AT–Ⅱ、NE、SAA各指标水平分别显著低于B组,差异均有统计学意义(P<0.05)。A组患者的并发症率为8.58%,明显低于B组的21.43%,差异有统计学意义(P<0.05)。两组患者的局部复发率、远处转移率、生存率比较,差异无统计学意义(P>0.05)。结论 与肺叶切除术比较,胸腔镜下肺楔形切除术能缩短老年NSCLC患者的手术、胸引流管置管和住院时间,减轻应激反应,降低并发症发生率,而中期复发和转移率未见增加。

Objective To investigate the effects of thoracoscopic wedge resection and lobectomy on serum(Ins),cortisol(Cor) and angiotensin–Ⅱ in early–stage elderly non–small cell lung cancer(NSCLC) Angiotensin Ⅱ(AT–Ⅱ),norepinephrine(NE), Serum amyloid A(SAA) and clinical efficacy was compared. Methods A total of 140 patients with early–stage elderly NSCLC who were treated in our hospital from February 2018 to February 2020 were selected and divided into group A and group B according to the random number table method, with 70 cases in each group.Group A underwent thoracoscopic wedge resection, and group B underwent lobectomy. The operation, chest tube placement, hospital stay, intraoperative blood loss and drainage volume were compared between the two groups, and blood was collected before surgery, on the day of surgery, and 1 week after surgery to detect Ins, Cor, AT–Ⅱ, NE, and SAA in the two groups. The changes in stress response were analyzed. The complications of the two groups were observed, and the local recurrence rate, distant metastasis rate and survival rate were analyzed. Results The operation,chest tube placement and hospital stay in group A were all shorter than those in group B, the intraoperative blood loss and drainage volumein group A were lower than those in group B, the differences were statistically significant significance(P<0.05). On the day of surgery and 1 week after surgery, the levels of INS, COR, AT–Ⅱ, NE, and SAA in group A were lower than those in group B,the differences were statistically significant(P<0.05). The complication rate of group A was 8.58%, which was significantly lower than 21.43% of group B, and the difference was statistically significant(P<0.05). There was no significant difference in local recurrence rate, distant metastasis rate and survival rate between groups A and B(P>0.05). Conclusion Compared with lobectomy, thoracoscopic pulmonary wedge resection can shorten the operation, catheterization and hospitalization time of elderly patients with NSCLC, the stress response is alleviated and the complication rate is reduced, but the mid–term recurrence and metastasis rate are not increased.