三维CT支气管血管成像模拟对单孔胸腔镜肺癌根治术淋巴结清扫数量及患者肺功能的影响

Effects of Three-dimensional CT Bronchial Angiography Simulation on the Number of Lymph Nodes Dissection and Lung Function in Patients Underwent Single-port Thoracoscopic Radical Resection of Lung Cancer

目的观察三维CT支气管血管成像模拟对单孔胸腔镜肺癌根治术淋巴结清扫数量及患者肺功能的影响。方法回顾性分析150例非小细胞肺癌患者资料,所有患者均接受单孔胸腔镜肺癌根治术治疗,根据术前规划方法不同分为观察组(77例)和对照组(73例),其中对照组术前接受常规CT扫描,观察组在此基础上接受三维CT支气管血管成像模拟。比较两组患者手术情况(手术时间、术中出血量、切缘宽度、淋巴结清扫数量、引流量、胸腔引流管放置时间、首次下床活动时间、住院时间)、术后疼痛[视觉模拟评分法(VAS)]、肺功能[最大自主通气量(MVV)、1秒用力呼气容积(FEV1)/用力肺活量(FVC)]、免疫功能(CD3^(+)、CD4^(+)/CD8^(+))、围手术期并发症、术后6个月内复发率。结果观察组术中出血量、引流量、胸腔引流管放置时间、首次下床活动时间、住院时间均优于对照组,术后1、2、3 d的VAS得分、术后3 d的CD3^(+)、CD4^(+)/CD8^(+)水平、围手术期并发症总发生率低于对照组,淋巴结清扫数、切缘宽度、术后1个月的MVV、FEV1/FVC大于对照组,差异有统计学意义(P<0.05);两组手术时间比较差异无统计学意义(P>0.05);术后随访6个月,两组均无患者复发转移。结论应用三维CT支气管血管成像模拟有助于减少单孔胸腔镜肺癌根治术的手术创伤,降低术后并发症风险,对维持肺功能及免疫功能有利,可有效缩短肺癌患者康复时间。

Objective To observe the effects of three-dimensional CT bronchial angiography simulation on the number of lymph node dissection and lung function in patients underwent single-port thoracoscopic radical resection of lung cancer.Methods The data of 150 patients with non-small cell lung cancer were reviewed.All patients received single-port thoracoscopic radical resection of lung cancer and were divided into the observation group(77 cases)and the control group(73 cases)according to different preoperative planning methods.The control group received routine CT scan before surgery while the observation group was given three-dimensional CT bronchial angiography simulation on this basis.The surgical conditions(surgical time,intraoperative blood loss,incision margin width,the number of lymph node dissection,drainage volume,time of thoracic drainage tube placement,first ambulation time,hospital stay),postoperative pain[Visual Analogue Scale(VAS)],lung function[maximum ventilatory ventilation volume(MVV),forced expiratory volume in 1 second(FEV1)/forced vital capacity(FVC)],immune function(CD3^(+),CD4^(+)/CD8^(+)),perioperative complications and recurrence rate within 6 months after surgery were compared between the 2 groups.Results The intraoperative blood loss,drainage volume,thoracic drainage tube placement time,first ambulation time and hospital stay in the observation group were all better than those in the control group,and the VAS scores at 1,2 and 3 days after surgery,levels of CD3^(+)and CD4^(+)/CD8^(+)at 3 days after surgery and total incidence rate of perioperative complications were lower than those in the control group,and the number of lymph node dissection,incision margin width and MVV and FEV1/FVC at 1 month after surgery were higher compared with those in control group(P<0.05).There was no statistical difference in surgical time between the 2 groups(P>0.05).At 6 months of follow-up after surgery,there was no recurrence and metastasis in both groups.Conclusion The application of three-dimensional CT bronchial angiography simulation is helpful to reduce the surgical trauma of single-port thoracoscopic radical resection of lung cancer,and lower the risk of postoperative complications,and it is beneficial to maintaining the lung function and immune function and can effectively shorten the rehabilitation time of patients with lung cancer.