单孔胸腔镜精准肺段切除术与肺叶切除术治疗早期非小细胞肺癌的临床疗效对比

Comparison on the Clinical Curative Effect of Single-Port Thoracoscopic Precise Segmentectomy and Lobectomy on Early Non-Small Cell Lung Cancer

目的:对比分析单孔胸腔镜下两种术式对早期非小细胞肺癌(NSCLC)临床疗效的影响。方法:回顾性分析本院2020年1月至2022年10月收治的108例早期NSCLC患者的临床资料,并按照手术方式的不同分成单孔胸腔镜精准肺段切除术组(A组,58例)和肺叶切除术组(B组,50例),术后随访5个月。比较两组围术期指标(手术时间、术中失血量、淋巴结清扫总数、胸管留置时间、胸腔引流量、住院时间)、肿瘤标志物[癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、糖类抗原50(CA50)]水平、肺功能指标[最大呼气流量(PEF)、最大肺活量(FVC)、1s用力呼气容积(FEV1)]、肺癌生存质量量表(EORTC QLQ-LC43)评分和术后并发症发生率的差异。结果:两组的淋巴结清扫总数、术中失血量、并发症发生率的差异均无统计学意义(P>0.05),A组的手术时间高于B组,胸管留置时间、胸腔引流量、住院时间均低于B组(P<0.05);术后3 d两组的CYFRA21-1、CEA、CA50水平均低于术前(P<0.05),而两组同组手术前后的差值均无统计学意义(P>0.05);术后5个月两组的PEF、FVC、FEV1均低于术前,而A组较B组下降幅度更小,手术前后的差值更小(P<0.05);术后5个月A组EORTC QLQ-LC43各项评分均高于B组(P<0.05)。结论:单孔胸腔镜下肺叶切除术、肺段切除术的疗效和安全性相当,但后者更有利于缩短康复进程,改善肺功能,提高生活质量。

Objective:To compare and analyze the clinical curative effect of two single-port thoracoscopy on early non-small cell lung cancer(NSCLC).Methods:A retrospective analysis was performed on the clinical data of 108 patients with early NSCLC admitted to the hospital between January 2020 and October 2022.According to different surgical methods,they were divided into single-port thoracoscopic precise segmentectomy group(group A,58 cases)and lobectomy group(group B,50 cases).All were followed up for 5 months after surgery.The differences in perioperative indexes(total number of lymph nodes dissection,intraoperative blood loss,operation time,indwelling time of thoracic catheter,thoracic drainage volume,hospitalization time),tumor markers[cytokeratin-19-fragment(CYFRA21-1),carcinoembryonic antigen(CEA),carbohydrate antigen 50(CA50)],lung function indexes[peak expiratory flow(PEF),forced vital capacity(FVC),forced expiratory volume in one second(FEV1)],differences in the Quality of Survival in Lung Cancer Scale(EORTC QLQ-LC43)scores,and postoperative complication rates were compared.Results:The differences in the total number of lymph node dissection,intraoperative blood loss,and complication rates between the two groups were not statistically significant(P>0.05),and the operative time in Group A was higher than that in Group B.The time of chest tube retention,chest drainage,and hospitalization were lower than that in Group B(P<0.05);the levels of CYFRA21-1,CEA,and CA50 in both groups were lower than those in the preoperative period at 3 d postoperatively(P<0.05),whereas the difference between the two groups before and after surgery was not statistically significant in the same group(P>0.05);at 5 months postoperatively,the levels of PEF,FVC,and FEV1 were lower than those in the preoperative period in both groups,whereas the decrease in group A was smaller than that in group B,with a smaller difference between the pre-and post-surgical periods(P<0.05);after 5 postoperative months,all EORTC QLQ-LC43 scores in group A were higher than those in group B(P<0.05).Conclusion:The single-port thoracoscopic lobectomy and segmentectomy have comparable curative effect and safety.However,the latter is more beneficial to shorten the rehabilitation process,improve lung function and quality of life.