胸腔镜下肺段及肺叶切除术治疗肺小结节后创伤应激及肺功能指标观察

Observation of traumatic stress and pulmonary function indexes after thoracoscopic lung segmentectomy and lobectomy for the treatment of small pulmonary nodules

目的探讨胸腔镜下肺段及肺叶切除术治疗肺小结节对创伤应激及肺功能指标的影响。方法本研究为非随机同期对照试验研究。采用非随机抽样的方法选取2019年1月至2021年12月在上海健康医学院附属崇明医院110例肺小结节患者,根据手术方式分为肺段切除术组(62例)与肺叶切除术组(48例)。比较2组手术时间、术中出血量、淋巴结数目、引流量、引流时间、住院时间,术前及术后3 d的皮质醇(Cor)、促肾上腺皮质激素(ACTH)、C反应蛋白(CRP)、白细胞介素6(IL-6),2组术后1 d、3 d、7 d的疼痛视觉模拟评分(VAS),术前及术后3个月第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、用力肺活量占预计值百分比(FVC%pred)、每分钟最大通气量占预计值百分比(MVV%pred)的改变值ΔFEV_(1)%pred、ΔFVC%pred、ΔMVV%pred,2组术后并发症。结果2组手术时间、淋巴结数目比较差异均无统计学意义(均P>0.05),肺段切除术组术中出血量、引流量、引流时间、住院时间均少于肺叶切除术组,差异均有统计学意义(均P<0.05)。术后3 d 2组Cor、ACTH、IL-6、CRP水平均高于术前,肺段切除术组Cor、ACTH、IL-6、CRP水平均低于肺叶切除术组,差异均有统计学意义(均P<0.05)。2组术后1 d、3 d、7 d的VAS评分呈逐渐降低趋势,但肺段切除术组VAS评分降低得更多,2组的组间、时点间以及组间·时点间的交互作用差异均有统计学意义(均P<0.05)。肺段切除术组ΔFEV_(1)%pred、ΔFVC%pred、ΔMVV%pred均低于肺叶切除术组[(8.89±2.52)%比(18.53±2.62)%、(8.21±2.15)%比(15.53±2.10)%、(9.37±2.71)%比(16.98±2.43)%],差异均有统计学意义(t值分别为19.56、17.89、15.27,均P<0.001)。2组术后并发症总发生率比较差异无统计学意义[4.84%(3/62)比12.50%(6/48),χ2=2.11,P>0.05]。结论胸腔镜下肺段及肺叶切除术治疗肺小结节均安全有效。胸腔镜下肺段切除术在减少术中出血量和引流量,缩短引流时间和住院时间,减轻创伤应激反应和疼痛程度,减少肺功能损伤等方面效果更好。

Objective To investigate the effect of thoracoscopic lung segmentectomy and lobectomy for the treatment of small pulmonary nodules on trauma stress and pulmonary function indexes.Methods This was a non-randomized concurrent control trial involving 110 patients with pulmonary nodules who were surgically treated in Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences from January 2019 to December 2021.They were recruited by non-random sampling method and divided into segmentectomy group(62 cases)and lobectomy group(48 cases)based on the surgical procedure.The surgery time,intraoperative blood loss,number of lymph nodes,drainage volume,drainage time and length of stay were compared between groups.The levels of cortisol(Cor),adrenocorticotropic hormone(ACTH),C-reactive protein(CRP),and interleukin(IL-6)before surgery and 3 days after surgery were compared between groups.The pain visual analog scale(VAS)at 1 d,3 d,and 7 d after surgery was compared between groups.Predicted forced expiratory volume in the first second(FEV_(1)%pred),predicted forced vital capacity(FVC%pred),predicted maximum voluntary ventilation(MVV%pred)before surgery and 3 months after surgery,and their changes(ΔFEV_(1)%pred,ΔFVC%pred,ΔMVV%pred)were compared between groups.The postoperative complications were compared between groups.Results There were no significant differences in the surgery time and number of lymph nodes between groups(both P>0.05).The intraoperative blood loss,drainage volume,drainage time and length of stay in the segmentectomy group were all significantly lower than those of the lobectomy group(all P<0.05).At 3 days after surgery,Cor,ACTH,IL-6 and CRP in both groups were significantly higher than those before surgery,and Cor,ACTH,IL-6 and CRP in the segmentectomy group were significantly lower than those of the lobectomy group(all P<0.05).VAS scores at 1 d,3 d and 7 d in both groups were gradually reduced,which were more pronounced in segmentectomy group.Moreover,significant differences in VAS scores were detected between groups,at each time point and group-by-time interaction(all P<0.05).TheΔFEV_(1)%pred([8.89±2.52]%vs[18.53±2.62]%,t=19.56),ΔFVC%pred([8.21±2.15]%vs[15.53±2.10]%,t=17.89)andΔMVV%pred([9.37±2.71]%vs[16.98±2.43]%,t=15.27)in the segmentectomy group were all significantly lower than those of lobectomy group(all P<0.001).No significant difference was detected in the overall incidence of postoperative complications between groups(4.84%[3/62]vs 12.50%[6/48],χ2=2.11,P>0.05).Conclusions Thoracoscopic lung segmentectomy and lobectomy are safe and effective in the treatment of small pulmonary nodules.Thoracoscopic lung segmentectomy is more effective on reducing intraoperative bleeding and drainage volume,shortening drainage time and length of stay,preventing traumatic stress response,pain degree and lung dysfunction.