aBVA解剖入路胸腔镜右上肺叶切除术对肺癌患者的应用效果

Effect of Thoracoscopic Right Upper Lobectomy via aBVA Anatomical Approach in Lung Cancer Patients

目的观察aBVA解剖入路胸腔镜右上肺叶切除术对肺癌患者机体内环境指标及恢复的影响。方法回顾性收集南阳市第二人民医院2021年1月至2022年12月胸腔镜右上肺叶切除术治疗的87例肺癌患者临床资料,将40例(依次解剖后升支动脉、支气管和动静脉)纳入aBVA组,将47例(依次解剖动静脉、支气管)纳入AVB组。比较两组患者术前、术后1 d、术后3 d时机体内环境指标[血清肌酸激酶(CK)、C反应蛋白(CRP)、白细胞介素-6(IL-6)],围手术期指标(术中出血量、手术时间、淋巴结清扫数量、胸腔引流时间、住院时间),术后并发症(肺炎、肺不张、胸腔积液、伤口感染、持续肺漏气、心律失常)发生情况。结果两组患者术前CK、CRP、IL-6水平比较,差异无统计学意义(P>0.05);术前、术后1 d和术后3 d,两组患者CK、CRP、IL-6水平呈先上升后下降的趋势,且aBVA组上升幅度小于AVB组(P<0.05)。aBVA组患者术中出血量少于AVB组,手术时间、胸腔引流时间、住院时间短于AVB组,差异有统计学意义(P<0.05)。两组患者淋巴结清扫数量、术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论aBVA解剖入路胸腔镜右上肺叶切除术能稳定肺癌患者机体内环境,促进患者术后恢复,安全性高。

Objective To observe the effect of thoracoscopic right upper lobectomy via aBVA anatomical approach on the internal environmental indicators and recovery of lung cancer patients.Methods Clinical data of 87 lung cancer patients treated with thoracoscopic right upper lobectomy in Nanyang Second General Hospital from January 2021 to December 2022 were retrospectively collected,and 40 patients(dissecting the posterior ascending branch artery,bronchus,and arteriovenous system in sequence)were included in the aBVA group,47 patients(dissecting the arteriovenous system and bronchus in sequence)were included in the AVB group.The body environment indexes[serum creatine kinase(CK),C-reactive protein(CRP),interleukin-6(IL-6)],perioperative indexes(intraoperative blood loss,operation time,number of lymph node dissection,thoracic drainage time,hospitalization time)and postoperative complications(pneumonia,atelectasis,pleural effusion,wound infection,persistent pulmonary air leakage,arrhythmia)were compared between the two groups before operation,1 day after operation and 3 days after operation.Results There were no differences in preoperative CK,CRP,and IL-6 levels between the two groups of patients(P>0.05).Before operation,1 day after operation and 3 days after operation,the levels of CK,CRP,and IL-6 in both groups of patients showed a trend of first increasing and then decreasing,and the increase in aBVA group was smaller than that in AVB group(P<0.05).The intraoperative bleeding volume of patients in the aBVA group was less than that in the AVB group,and the surgical time,thoracic drainage time,and hospitalization time were shorter than those in the AVB group(P<0.05).There were no differences in the number of lymph node dissection and the total incidence of postoperative complications between the two groups of patients(P>0.05).Conclusion The aBVA anatomical approach thoracoscopic right upper lobectomy can stabilize the internal environment of lung cancer patients,promote postoperative recovery,and have high safety.