老年人非小细胞肺癌肺段切除与肺叶切除的手术的治疗效果分析

Analysis of the therapeutic effects of segmental resection and lobectomy for the elderly patients with nonsmall cell lung cancer

目的比较老年人非小细胞肺癌在胸腔镜下分别采取肺段切除与肺叶切除术的治疗效果。方法选取我院收治的260例年龄>65岁的老年非小细胞肺癌患者,随机将其分为对照组与研究组,各组例数均为130例。对照组经胸腔镜采取肺叶切除术,研究组则经胸腔镜采取肺段切除术。分析比较两组患者手术指标及患者手术前后第1秒用力呼气量(FEV)和肺活量(FVC)。结果研究组患者术中出血量、淋巴结切除量及术后视觉模拟评分法(VAS)评分与对照组比较差异无统计学意义(均P>0.05),研究组患者手术操作时间为(136.5±34.9)min明显长于对照组(120.8±30.2)min(t=3.876,P<0.001),研究组患者引流时间和总住院时间分别为(4.2±0.5)d和(7.2±1.6)d,分别明显低于对照组的(4.9±0.8)d和(8.7±2.1)d(t=8.445和6.421,均P<0.001)。对照组患者术前FEV,和FVC分别为(99.25±7.15)%和(99.60±7.54)%,术后FEV1和FVC分别为(65.08±13.06)%和(68.64±13.04)%,观察组患者术前FEV1和FVC分别为(98.42±8.99)%和(100.50±7.35)%,术后FEV1和FVC分别为(85.09±10.04)%和(86.79±15.88)%,两组患者术后FEV,和FVC水平明显低于术前(t=13.850和24.268,均P<0.001),但研究组患者术后FEV和FVC水平明显高于对照组(P<0.05)。两组患者并发症差异无统计学意义(P>0.05)。结论与胸腔镜肺叶切除术相比,胸腔镜下肺段切除术更有助于减少老年非小细胞癌患者术后引流时间以及住院时间,以及保护患者肺功能。

Objective To compare the efficacies of thoracoscopic segmentectomy and lobectomy in the treatment of elderly non-small cell lung cancer.Methods 260 elderly patients with non-small cell lung cancer(NSCLC)aged>65 years were randomly divided into a control group and a study group,with 130 in each group.The control group received lobectomy via the thoracoscope,while the study group received segmentectomy via the thoracoscope.Data from parameters for surgical performance of the two groups were analyzed and compared.The forced expiratory volume in one second(FEV1)and forced vital capacity(FVC)before and after surgery were compared between the two groups.Results There was no significant difference between patients in the study group and the control group in the volume of intraoperative bleeding,the number of lymph node resection and the postoperative VAS score(all P>0.05).The operative time of the study group was(136.5±34.9)min,clearly longer than that of the control group(120.8±30.2)min,and the difference between the groups was significant(t=3.876,P<0.001),and the drainage time and total hospital stay for patients in the study group were(4.2±0.5)d and(7.2±1.6)d,respectively,which were much shorter than those for the control group(4.9±0.8)d and(8.7±2.1)d,respectively,and the differences between the groups were significant(t=8.445 and 6.421,P<0.001 for both).For the control group,the preoperative FEV1 and FVC were(99.25±7.15)%and(99.60±7.54)%,respectively.and the postoperative FEV1 and FVC were(65.08±13.06)%and(68.64±13.04)%,respectively;for the study group,the preoperative FEV1 and FVC were(98.42±8.99)%and(100.50±7.35)%,respectively,and the postoperative FEV1 and FVC were(85.09±10.04)%and(86.79±15.88)%,respectively.For both groups,the FEV and FVC levels after surgery were significantly lower than those before surgery(P<O.05),but the FEV1 and FVC levels in the study group were significantly higher than those in the control group(t=13.850 and 24.268,P<0.001 for both).There was no significant difference in the incidence of complications between the two groups(P>O.05).Conclusions Compared with thoracoscopic lobectomy,thoracoscopic segmentectomy is more helpful to reduce postoperative drainage time and hospitalization time for elderly patients with non-small cell lung cancer,and can better protect patients'lung function.