胸腔镜肺癌精准切除术在非小细胞肺癌患者中的应用

Application of Thoracoscopic Precise Resection of Lung Cancer in Patients with Non-small Cell Lung Cancer

目的 研究胸腔镜肺癌精准切除术在非小细胞肺癌患者治疗中的应用。方法 选取2019年1月至2021年1月于驻马店市中医院肿瘤外科就诊的150例肺癌患者为研究对象,根据治疗方式将患者分为常规组和精准组,各75例。常规组接受传统胸腔镜手术,精准组接受胸腔镜肺癌精准切除术。比较两组围手术期指标、并发症情况和术前及术后3、7 d免疫功能指标[免疫球蛋白A(IgA)、IgG、IgM],随访1 a,记录术前和术后6个月、1 a肺功能指标[用力肺活量占预计值百分比(FVC%)、每分钟最大通气量占预计值百分比(MVV%)、第1秒用力呼气容积占预计值百分比(FEV_(1)%)]及复发情况。结果 精准组手术时间长于常规组,引流时间、留院时间短于常规组,术中出血量、淋巴结清扫数均少于常规组,治疗费用高于常规组(P<0.05);精准组并发症总发生率(16.00%)低于常规组(30.67%)(P<0.05);术后3、7 d精准组IgA、IgG、IgM高于常规组(P<0.05);术后6个月、1 a精准组FVC%、MVV%、FEV_(1)%均高于常规组(P<0.05);精准组复发率(6.85%)与常规组(2.78%)比较,差异无统计学意义(P>0.05)。结论 胸腔镜肺癌精准切除术能减轻免疫功能损伤,在短期恢复方面具有显著优势,有助于改善术后肺功能,提高治疗安全性,但操作难度较大,手术时间较长,治疗费用较高。

Objective To study the value of thoracoscopic precision lung cancer resection in the treatment of lung cancer patients.Methods One hundred and fifty patients with lung cancer who attended our surgical oncology department from January 2019 to January 2021 were selected for the study,and the patients were divided into conventional and precision groups according to the treatment modality,with 75 cases each group.The conventional group underwent conventional thoracoscopic surgery,and the precision group underwent thoracoscopic precision lung cancer resection.The perioperative indexes,complications,immune function indexes[immunoglobulin A(IgA),IgG,IgM]before and 3 d and 7 d after surgery were compared between the two groups,and the lung function indexes[forceful lung volume as a percentage of the expected value(FVC%),maximum ventilation per minute as a percentage of the expected value(MVV%),first second forceful expiratory volume as a percentage of the expected value(FEV_(1)%)]levels and recurrence were recorded before surgery,6 months and 1 year after surgery.Results The operation time in the precision group was longer than that in the conventional group,the drainage time and hospital stay were shorter than those in the conventional group,the intraoperative bleeding and the number of lymph node dissection were less than those in the conventional group,and the treatment cost was higher than that in the conventional group(P<0.05).The total complication rate in the precision group(16.00%)was lower than that in the conventional group(30.67%)(P<0.05).The IgA,IgG,and IgM in the precision group were higher than those in the conventional group at 3 d and 7 d after surgery(P<0.05).FVC%,MVV%,FEV_(1)%were higher in the precision group than those in the conventional group at 6 months and 1 year after surgery(P<0.05).There was no significant difference between the recurrence rate in the precision group(6.85%)and in the conventional group(2.78%)(P>0.05).Conclusion Thoracoscopic precision lung cancer resection can reduce immune function damage,has significant advantages in short-term recovery,and can help to improve postoperative lung function,and increase treatment safety,but is more difficult to operate,takes longer to operate,and is more expensive to treat.