单孔及三孔胸腔镜术式对早期非小细胞肺癌患者淋巴结清扫情况及肺功能影响的对比观察

Comparative Observation on Effect of Single-hole and Three-hole Thoracoscopy on Lymph Node Dissection and Pulmonary Function in Patients with Early Non-small Cell Lung Cancer

目的:分析对比单孔及三孔胸腔镜术式在早期非小细胞肺癌(NSCLC)治疗中的应用价值。方法:按照手术方案将南充市中心医院2018年1月-2020年3月收治的86例早期NSCLC患者分为单孔组(43例,行单孔操作胸腔镜手术)与三孔组(43例,行三孔操作胸腔镜手术)。对比两组围手术期基本指标(手术切口长度、手术时间、手术出血量、淋巴结清扫数目)、术后2、24、72 h切口疼痛情况、并发症发生率、术前及术后72 h肺功能指标[用力肺活量(FVC)、一秒率(FEV1%)及最大自主通气量(MVV)]变化。结果:单孔组手术切口长度、手术出血量均优于三孔组,手术时间长于三孔组(P<0.05),但两组淋巴结清扫数目比较差异无统计学意义(P>0.05);单孔组术后24、术后72 h疼痛评分均低于三孔组(P<0.05),且术后并发症发生率为2.33%,低于三孔组的18.60%(P<0.05);术后72 h,两组FVC、FEV1%及MVV较术前均降低,但单孔组均高于三孔组(P<0.05)。结论:单孔胸腔镜手术治疗早期NSCLC较三孔操作手术创伤更小,有利于减轻术后疼痛,降低并发症发生率,保护患者肺功能,且可取得与三孔操作相当的淋巴结清扫效果。

Objective:To analyze and compare the application value of single-hole and three-hole thoracoscopy in the treatment of early non-small cell lung cancer(NSCLC).Method:According to the surgical plan,86 patients with early NSCLC who treated in Nanchong Central Hospital from January 2018 to March 2020 were divided into single-hole group(43 patients underwent single-hole operation thoracoscopic surgery)and three-hole group(43 patients underwent three-hole operation thoracoscopic surgery).The changes of basic perioperative indexes(incision length,operation time,operative bleeding volume,number of lymph node dissections),incision pain 2,24,72 h after operation,complication rate,pulmonary function indexes[forced vital capacity(FVC),one second rate(FEV1%)and maximal voluntary ventilation(MVV)]before and 72 h after operation were compared between the two groups.Result:The incision length and bleeding volume of the single-hole group were better than those of the three-hole group,and the operation time was longer than that of the three-hole group(P<0.05),but there was no significant difference in the number of lymph node dissections between two groups(P>0.05).The pain score in the single-hole group at 24 and 72 h after operation were lower than those in the three-hole group(P<0.05),and the incidence of postoperative complications was 2.33%,which was lower than 18.60%in the three-hole group(P<0.05).After 72 h of operation,FVC,FEV1%and MVV in two groups were lower than those before operation,but the single-hole group were higher than those in the three-hole group(P<0.05).Conclusion:Single-hole thoracoscopic surgery for early NSCLC has less trauma than three-hole operation,which is conducive to reducing postoperative pain,reducing the incidence of complications,protecting patients’lung function,and achieving comparable lymph node dissection effect with three-hole operation.