达芬奇机器人左肺上叶切除术治疗肺癌的疗效及术后慢性咳嗽影响因素分析

Analysis of the curative effect of left upper lobectomy with Da Vinci robot in the treatment of lung cancer and the influencing factors of postoperative chronic cough

目的 探讨达芬奇机器人左肺上叶切除术治疗肺癌的疗效及术后慢性咳嗽影响因素。方法 回顾性选取2020年1月至2022年10月江苏省肿瘤医院收治的220例肺癌患者作为研究对象,依照患者手术方式的不同进行分组,将采取常规胸腔镜手术的80例患者分为对照组,将采取达芬奇机器人左肺上叶切除术治疗的140例患者分为观察组。比较两组患者围手术期相关指标,淋巴结清扫个数、纵膈淋巴结清扫站数以及纵膈淋巴结清扫个数,术后并发症发生率、术后慢性咳嗽发生率和中转开腹率。随后对采取达芬奇机器人左肺上叶切除术的140例患者依照术后慢性咳嗽发生情况进行分组,将35例出现慢性咳嗽的患者分为慢性咳嗽组,将其余105例患者分为非慢性咳嗽组,分析影响慢性咳嗽发生的单因素,并采取Logistic回归分析法分析达芬奇机器人左肺上叶切除术后慢性咳嗽的独立影响因素。结果 观察组患者的手术时间、手术出血量、术后总引流量、使用抗生素时间、ICU停留时间以及住院时间均明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者的淋巴结清扫个数、纵膈淋巴结清扫站数以及纵膈淋巴结清扫个数均明显高于对照组,差异均有统计学意义(P<0.05)。两组患者中转开腹率、术后慢性咳嗽发生率比较,差异均无统计学意义(P>0.05),观察组患者并发症发生率低于对照组,差异有统计学意义(P<0.05)。慢性咳嗽组与非慢性咳嗽组患者性别、体重指数、吸烟史、临床分期、病理类型比较,差异均无统计学意义(P>0.05),慢性咳嗽组与非慢性咳嗽组患者年龄、手术范围、术前咳嗽、淋巴结清除数比较,差异均有统计学意义(P<0.05)。Logistic回归分析结果表明:年龄、手术范围、术前咳嗽为达芬奇机器人左肺上叶切除术后慢性咳嗽的独立危险因素(P<0.05)。结论 达芬奇机器人左肺上叶切除术治疗肺癌疗效显著,可减少患者术中损伤,降低出血量,在促进患者早日康复的同时,能够提升患者淋巴清扫情况,但依然有15.00%的患者出现术后慢性咳嗽情况。同时年龄、手术范围、术前咳嗽为达芬奇机器人左肺上叶切除术后慢性咳嗽的独立危险因素,因此对年龄较大、手术范围为肺叶和术前咳嗽的患者需采取相关措施进一步预防患者术后慢性咳嗽的发生。

Objective To explore the curative effect of left upper lobectomy with Da Vinci robot in the treatment of lung cancer and the influencing factors of postoperative chronic cough.Methods A total of 220 patients with lung cancer who were admitted to Jiangsu Cancer Hospital from January 2020 to October 2022 were retrospectively selected as the study subjects.According to the different surgical methods used by patients,80 patients who underwent conventional thoracoscopic surgery were divided into the matched group,and 140 patients who underwent left upper lobectomy by Da Vinci robot were divided into the observation group.The number of lymph nodes cleaned,the number of mediastinal lymph nodes cleaned and the number of mediastinal lymph nodes cleaned,the incidence of postoperative complications,the incidence of postoperative chronic cough and the conversion to laparotomy were compared between the two groups.Subsequently,140 patients who underwent left upper lobectomy with Leonardo Da Vinci robot were divided into groups according to the occurrence of chronic cough after surgery,35 patients with chronic cough were divided into chronic cough group,and the remaining 105 patients were divided into non-chronic cough group.The single factors affecting the occurrence of chronic cough were analyzed,and the independent factors affecting chronic cough after left upper lobectomy with Leonardo Da Vinci robot were analyzed by Logistic regression analysis.Results The operation time,operation bleeding volume,total postoperative drainage volume,antibiotic use time,ICU stay time and hospitalization time of patients in the observation group were lower than those in the matched group,the differences were statistically significant(P<0.05).The number of lymph node dissection,mediastinal lymph node dissection stations and mediastinal lymph node dissection in the observation group were higher than those in the matched group,the differences were statistically significant(P<0.05).There was no statistically significant difference between the two groups in the conversion rate to laparotomy and the incidence of postoperative chronic cough(P>0.05).The incidence of complications in the observation group was lower than that in the matched group,the difference was statistically significant(P<0.05).There was no statistically significant differences in sex,BMI,smoking history,clinical stage and pathological type between chronic cough group and non-chronic cough group(P>0.05),the results of logistic regression analysis showed that age,surgical scope and preoperative cough were independent risk factors for chronic cough after left upper lobectomy by Da Vinci robot(P<0.05).Conclusion Da Vinci robot left upper lobectomy is effective in the treatment of lung cancer.It can reduce the intraoperative injury,reduce the amount of bleeding,and promote the early recovery of patients.At the same time,it can improve the lymph node clearance of patients.However,15.00%of patients still have chronic cough after surgery.At the same time,age,surgical scope and preoperative cough are independent risk factors for chronic cough after left upper lobectomy by Da Vinci robot.Therefore,relevant measures should be taken to further prevent the occurrence of postoperative chronic cough in patients who are older and whose surgical scope is lobectomy and preoperative cough.