单操作孔电视胸腔镜手术治疗对早期肺癌患者围术期免疫、炎性应激指标及术后肺功能的影响

Effects of Single-Port Video-assisted Thoracoscopic Surgery on Perioperative Immunity,Inflammatory Stress Indexes and Postoperative Pulmonary Function in Patients with Early-stage Lung Cancer

目的探讨单操作孔电视胸腔镜手术(VATS)对早期肺癌患者围术期免疫、炎性应激指标及术后肺功能的影响。方法回顾分析2017年9月—2020年6月收治的156例早期肺癌临床资料,根据患者手术方式进行分组,将采用传统胸腔镜三孔法治疗者83例纳入对照组,将采用单操作孔VATS治疗者73例纳入研究组,比较2组近期疗效、手术指标及围术期免疫指标、炎性应激指标和肺功能指标,以及术后并发症发生情况。结果研究组住院时间、术后肛门排气时间、首次下床时间、手术时间均明显短于对照组,术中出血量少于对照组(P<0.01)。术后3 d,2组CD3+、CD4+、CD8+、CD4+/CD8+较术前明显下降,但研究组CD3+、CD4+、CD8+、CD4+/CD8+均大于对照组(P<0.05,P<0.01)。术后3 d,2组超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平较术前明显上升,但研究组hs-CRP、IL-6、TNF-α均低于对照组(P<0.05,P<0.01)。术后1个月,2组第一秒用力呼吸容积(FEV1)、用力肺活量(FVC)水平明显降低,但研究组FEV1、FVC高于对照组(P<0.05,P<0.01)。研究组术后并发症总发生率明显低于对照组(P<0.05)。结论单操作孔VATS治疗早期肺癌近期效果显著优于传统胸腔镜三孔法治疗,对患者免疫功能影响小,可有效减少手术应激反应及对肺功能的损伤,且术后并发症发生率低,是一种安全可靠的手术治疗方式。

Objective To investigate the effect of single-port video-assisted thoracoscopic surgery(VATS)on perioperative immunity,inflammatory stress indicators and postoperative pulmonary function in patients with early-stage lung cancer.Methods The clinical data of 156 patients with early stage lung cancer who were treated from September 2017 to June 2020 were retrospectively analyzed,and the patients were divided into groups according to the surgical methods.Eighty-three patients treated with traditional three-port thoracoscopic surgery were included in the control group,and 73 patients treated with single-port VATS were included in the research group.The short-term efficacy,surgical indicators,perioperative immune indicators,inflammatory stress indicators,postoperative pulmonary function indicators,and postoperative complications were compared between the two groups.Results The length of hospital stay,postoperative anal exhaust time,first time of off-bed activity,and duration of operation in the research group were significantly shorter than those in the control group,and the intraoperative blood loss was less than that in the control group(P<0.01).On the 3rd day after operation,CD3+,CD4+,CD8+,CD4+/CD8+in both groups were significantly decreased compared with those before operation,but CD3+,CD4+,CD8+,CD4+/CD8+in the research group were higher than those in the control group(P<0.05,P<0.01).On the 3rd day after operation,the levels of high-sensitivity C reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the two groups were significantly increased compared with those before operation,which were lower in the research group than in the control group(P<0.05,P<0.01).At one month after operation,the levels of forced expiratory volume in one second(FEV1)and forced vital capacity(FVC)in the two groups were significantly decreased,but FEV1 and FVC in the research group were higher than those in the control group(P<0.05,P<0.01).The total incidence of postoperative complications in the research group was significantly lower than that in the control group(P<0.05).Conclusion The short-term effect of single-port VATS in the treatment of early-stage lung cancer is significantly better than that of the traditional three-port thoracoscopic surgery,which has little impact on the patient's immune function,can effectively reduce surgical stress and damage to pulmonary function,and has a low incidence of postoperative complications.Therefore,it is a safe and reliable surgical treatment.