CT引导下肺结节定位针拖尾法定位联合胸腔镜肺段切除术治疗早期肺腺癌的临床效果

Clinical effect of CT-guided localization of pulmonary nodule with locating needle and trailing technique combined with thoracoscopic pulmonary segmentectomy for the treatment of pulmonary adenocarcinoma in early stage

目的 探讨CT引导下肺结节定位针拖尾法定位联合胸腔镜肺段切除术治疗早期肺腺癌的临床效果。方法 选取110例早期肺腺癌患者,随机分为观察组(n=57)和对照组(n=53)。给予观察组CT引导下肺结节定位针拖尾法定位联合胸腔镜肺段切除术治疗,给予对照组常规CT引导定位联合胸腔镜肺段切除术治疗。比较两组患者的手术指标,手术前后的肺功能指标、肿瘤标志物、生存质量,以及手术并发症发生率。结果 观察组患者的定位时间、引流时间和术后住院天数短于对照组,一次定位准确率高于对照组(P<0.05),但两组的手术时间、术中出血量、引流量、淋巴结清扫数差异无统计学意义(P>0.05)。术后3个月,两组患者的最大自主通气量、第1秒用力呼气容积、用力肺活量、一氧化碳弥散量比较术前降低,但观察组上述肺功能指标优于对照组(P<0.05);两组患者生存质量各领域得分和总得分较术前升高(P<0.05),但两组生存质量各领域得分和总得分差异无统计学意义(P>0.05);手术前后两组患者的血清癌胚抗原、糖类抗原125、细胞角蛋白19片段抗原21-1、鳞状细胞癌抗原水平差异无统计学意义,两组患者手术并发症发生率差异亦无统计学意义(P>0.05)。结论 行胸腔镜肺段切除术治疗早期肺腺癌时,采用CT引导下肺结节定位针拖尾法定位有助于术前精准定位病灶,缩短术中定位时间和引流时间,对患者肺功能影响小,促进患者术后恢复。

Objective To investigate the clinical effect of CT-guided localization of pulmonary nodule with locating needle and trailing technique combined with thoracoscopic pulmonary segmentectomy for the treatment of pulmonary adenocarcinoma in early stage.Methods A total of 110 patients with pulmonary adenocarcinoma in early stage were selected,and they were randomly divided into observation group(n=57)or control group(n=53).The observation group was treated with CT-guided localization of pulmonary nodule with locating needle and trailing technique combined with thoracoscopic pulmonary segementectomy,while the control group received routine CT-guided localization combined with thoracoscopic pulmonary segmentectomy for treatment.The operative indices,and pre-and postoperative pulmonary function indices,tumor markers,survival quality,as well as the incidence rate of operative complications were compared between the two groups.Results The localization time,drainage time,and postoperative length of hospital stay in the observation group were shorter than those in the control group,and the accuracy rate of one-time localization was higher than that in the control group(P<0.05);however,no statistically significant difference in operation duration,intraoperative bleeding volume,drainage volume,and number of lymph node dissection was found between the two groups(P>0.05).After 3 months of operation,the maximum voluntary ventilation,forced expiratory volume in one second,forced vital capacity,and diffusion lung capacity for carbon monoxide in the two groups were decreased as compared with before operation,but the observation group exhibited superior aforementioned pulmonary function indices to compared with the control group(P<0.05).The scores of quality of survival in various fields and total score in the two groups were elevated as compared with before operation(P<0.05),but there was no statistically significant difference in the scores of quality of survival in various fields and total score between the two groups(P>0.05).There was no statistically significant difference in pre-and postoperative serum carcinoembryonic antigen,carbohydrate antigen 125,cytokeratin 19 fragment antigen 21-1,and squamous cell carcinoma antigen levels between the two groups,and no statistically significant difference in the incidence rate of operative complications was found between the two groups(P>0.05).Conclusion When undergoing thoracoscopic pulmonary segmentectomy for the treatment of pulmonary adenocarcinoma in early stage,employing CT-guided localization of pulmonary nodule with locating needle and trailing technique is helpful for preoperative accurate localization of lesions,shortening intraoperative localization time and drainage time,which has less effect on patients′pulmonary function,and promotes patients′postoperative recovery.