Hookwire定位下单孔胸腔镜手术治疗外周型肺GGO病变的疗效及对机体免疫功能的影响

Effect of hookwire localized single hole thoracoscopic surgery on peripheral pulmonary GGO lesions and its influence on immune function

目的:探讨肺部结节带钩金属导丝(Hookwire)定位下单孔胸腔镜手术治疗外周型肺局灶性磨玻璃影(GGO)病变疗效及对机体免疫功能的影响。方法:选取90例行单孔胸腔镜手术肺GGO病变患者为研究对象,根据手术定位方式不同分为观察组和对照组,每组各45例。观察组患者采用Hookwire定位;对照组患者采用阅读CT结合术中器械触诊定位。比较两组患者定位成功率、开胸手术率、术中出血率、住院时间、术后并发症发生率及术前和术后的二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))、pH值、C反应蛋白(CRP)、白细胞介素-6(IL-6)、IL-10、CD3^(+)、CD4^(+)、NK细胞水平。结果:观察组患者定位成功率大于对照组(P<0.05);两组患者术中出血率、住院时间、开胸率比较,差异均无统计意义(P>0.05)。术前及术后1 d,两组患者PaCO_(2)、PaO_(2)、pH值、CRP、IL-6、IL-10、CD3^(+)、CD4^(+)、NK细胞水平比较,差异均无统计学意义(P>0.05)。术后1 d,两组患者PaCO_(2)、PaO_(2)、pH值、CD3^(+)、CD4^(+)、NK细胞水平均低于术前(P<0.05);CRP、IL-6、IL-10水平均高于术前(P<0.05)。两组患者术后总并发症发生率比较,差异无统计学意义(P>0.05)。结论:单孔胸腔镜手术治疗外周型肺GGO病变前使用Hookwire定位,能提高定位成功率,不增加术中出血量和免疫功能的损伤。

Objective:To investigate the effect of single hole thoracoscopic surgery on peripheral pulmonary focal ground glass opacity(GGO)lesions under hook wire localization of pulmonary nodules and its influence on immune function.Methods:90 patients with pulmonary GGO lesions were selected as the research subjects,all of whom underwent single hole video-assisted thoracoscopic surgery.They were divided into the observation group and the control group according to different surgical positioning methods,with 45 cases in each group.The patients in the observation group were positioned with Hookwoire,the patients in the control group were treated with reading CT combined with intraoperative instrument palpation.The success rate of localization,the rate of thoracotomy,the rate of intraoperative bleeding,the length of hospital stay,the incidence of postoperative complications and preoperative and postoperative,partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),pH value,C-reactive protein(CRP),interleukin-6(IL-6),interleukin-10(IL-10),CD3^(+),CD4^(+),and NK cell levels were compared between the two groups.Results:The success rate of positioning in observation group was higher than that in control group(P<0.05).There were no significant differences in the rate of intraoperative bleeding,length of stay and thoracotomy between the two groups(P>0.05).There were no significant differences in PaCO_(2),PaO_(2),and pH values,and the levels of CRP,IL-6,IL-10,CD3^(+),CD4^(+)and NK between the two groups before surgery and 1 day after surgery(P>0.05).The PaCO_(2),PaO_(2),and pH values,and the levels of CD3^(+),CD4^(+)and NK between the two groups 1 day after surgery were lower than those before surgery(P<0.05),and the levels of CRP,IL-6,and IL-10 were higher than those before surgery(P<0.05).There was no significant difference in the total complications between the two groups(P>0.05).Conclusion:Before single-hole thoracoscopic surgery for peripheral pulmonary GGO lesions,using Hookwire localization can improve the success rate of localization,without increasing intraoperative blood loss,and with less damage to immune function.