单操作孔电视胸腔镜手术和多操作孔电视胸腔镜手术对早期肺癌患者肺功能及应激反应的影响

Effects of single utility port video-assisted thoracoscopic surgery and multi port video-assisted thoracoscopic surgery on lung function and stress response in patients with early stage lung cancer

目的探究单操作孔电视胸腔镜手术(SP-VATS)、多操作孔电视胸腔镜手术(MP-VATS)对早期肺癌患者肺功能、应激反应的影响。方法选取2018年5月至2021年5月本院收治的90例早期肺癌患者作为研究对象,随机分为MP-VATS组与SP-VATS组,各45例。MP-VATS组行MP-VATS,SP-VATS组行SP-VATS,比较两组手术相关指标,治疗前后肺功能指标、免疫功能、应激因子水平,并发症发生情况,局部复发情况。结果SP-VATS组出血量、术后引流量均少于MP-VATS组,胸管留置时间短于MP-VATS组,清扫淋巴结个数多于MP-VATS组,差异有统计学意义(P<0.05)。治疗前,两组第1秒用力呼气容积(FEV_(1))、最大呼气流量(PEF)、每分钟最大通气量(MVV)比较差异无统计学意义;治疗后,两组FEV_(1)、PEF、MMV均低于治疗前,但SP-VATS组高于MP-VATS组,差异有统计学意义(P<0.05)。治疗前,两组CD4^(+)、CD8^(+)水平比较差异无统计学意义;治疗后,两组CD4^(+)水平高于治疗前,CD8^(+)水平低于治疗前,但SP-VATS组CD4^(+)水平低于MP-VATS组,CD8^(+)水平高于于MP-VATS组,差异有统计学意义(P<0.05)。两组局部复发率比较差异无统计学意义;SP-VATS组并发症发生率为11.11%,低于MP-VATS组的28.89%,差异有统计学意义(P<0.05)。结论采用SP-VATS治疗早期肺癌,患者胸管留置时间较短,术中出血量、术后引流量较少,清扫淋巴结个数较多,且该治疗方案对患者肺功能、免疫功能影响较小,手术应激反应较轻,手术安全性较高,值得临床推广应用。

Objective To investigate the effects of single utility port video-assisted thoracoscopic surgery(SP-VATS)and multi port video-assisted thoracoscopic surgery(MP-VATS)on lung function and stress response in patients with early stage lung cancer.Methods 90 patients with early stage lung cancer admitted to our hospital from May 2018 to May 2021 were selected as the study subjects,and they were randomly divided into the MP-VATS group and the SP-VATS group,with 45 cases in each group.The MP-VATS group was treated with MP-VATS,and the SP-VATS group was treated with SP-VATS,the surgical related indexes,lung function indexes,immune function,stress factor levels before and after treatment,complications and local recurrence were compared between the two groups.Results The amount of blood loss and postoperative drainage in the SP-VATS group were lower than those in the MP-VATS group,the retention time of chest tube was shorter than that in the MP-VATS group,and the number of lymph nodes removed was higher than that in the MP-VATS group,the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),maximum ventilatory volume(MVV)between the two groups;after treatment,FEV1,PEF and MMV of the two groups were lower than those before treatment,and the SP-VATS group was higher than the MP-VATS group,the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in CD4^(+)and CD8^(+)levels between the two groups;after treatment,the levels of CD4^(+)were higher than those before treatment,and the levels of CD8^(+)were lower than those before treatment,and the level of CD4^(+)in the SP-VATS group was higher than that in the MP-VATS group,and the level of CD8^(+)was higher than that in the MP-VATS group,the differences were statistically significant(P<0.05).There was no significant difference in local recurrence rate between the two groups.The incidence of complications in SP-VATS group was 11.11%,which was lower than 28.89%in the MP-VATS group,and the differences were statistically significant(P<0.05).Conclusions SP-VATS in the treatment of early lung cancer has shorter retention time of chest tube,less intraoperative blood loss,less postoperative drainage volume,and more lymph node removal.and the treatment plan has less impact on lung function and immune function of patients,less surgical stress reaction,and higher surgical safety,which is worthy of clinical promotion and application.