3D-CTBA精准定位应用于胸腔镜肺段切除术患者的临床价值

Clinical value of 3D-CTBA precise localization in patients undergoing thoracoscopic segmentectomy for early NSCLC

目的探讨三维计算机断层扫描支气管血管成像(3D-CTBA)精准定位对胸腔镜肺段切除术患者糖类抗原125(CA125)、CA724、癌胚抗原(CEA)及肺功能的改善效果。方法前瞻性选取2019年8月至2022年8月安阳市中医院收治的135例行胸腔镜肺段切除术的早期非小细胞肺癌(NSCLC)患者,以随机数字表法分为对照组(67例)和研究组(68例)。对照组中男性42例,女性25例,年龄(58.75±6.81)岁,肿瘤长径(1.39±0.25)cm;研究组患者中男性41例,女性27例,年龄(58.22±6.35)岁,肿瘤长径(1.36±0.31)cm。对照组患者行胸腔镜肺段切除术;研究组患者在胸腔镜肺段切除术前行3D-CTBA精准定位。对比两组患者手术相关指标,术前、术后7 d血清肿瘤标志物水平,术前、术后1个月肺功能指标的变化,两组患者并发症发生情况。采用χ^(2)检验和独立样本t检验。结果研究组患者手术时间[(115.77±7.96)min]、胸腔引流管拔除时间[(3.48±0.81)d]均短于对照组[(140.05±8.77)min、(4.52±0.74)d],术中出血量、术后引流量均比对照组少[(129.83±11.65)ml比(150.02±10.23)ml、(541.23±41.78)ml比(720.22±56.66)ml],淋巴结清扫个数比对照组多[(11.86±2.44)个比(9.26±2.31)个](均P<0.05);术后7 d,两组患者血清CA125、CA724、CEA水平均较术前下降,且研究组[(29.88±6.15)U/ml、(11.75±7.08)U/ml、(15.55±5.67)µg/L]均低于对照组[(36.78±5.42)U/ml、(18.35±6.24)U/ml、(21.22±6.45)µg/L](均P<0.05);术后1个月,两组患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大呼气峰值流速(PEF)均较术前下降,但研究组[(2.95±0.58)L、(1.68±0.19)L、(4.73±0.59)L/s]均高于对照组[(2.72±0.65)L、(1.50±0.33)L、(4.50±0.57)L/s](均P<0.05)。研究组患者的并发症总发生率为10.29%(7/68),低于对照组的29.85%(20/67),差异有统计学意义(χ^(2)=8.067,P=0.005)。结论3D-CTBA精准定位应用于早期NSCLC胸腔镜肺段切除术患者中,可降低血清肿瘤标志物水平,减少对肺功能的影响,且并发症少,手术安全性高。

Objective To investigate the effect of three-dimensional computed tomography bronchography and angiography(3D-CTBA)precise localization on the improvement of carbohydrate antigen 125(CA125),carbohydrate antigen 724(CA724),carcinoembryonic antigen(CEA),and lung function in patients with thoracoscopic segmentectomy.Methods A total of 135 patients with early non-small cell lung cancer(NSCLC)who underwent thoracoscopic segmentectomy in Anyang Hospital of Traditional Chinese Medicine from August 2019 to August 2022 were prospectively selected and were divided into a control group(67 cases)and a study group(68 cases)by the random number table method.In the control group,there were 42 males and 25 females,aged(58.75±6.81)years,with a tumor diameter of(1.39±0.25)cm;in the study group,there were 41 males and 27 females,aged(58.22±6.35)years,with a tumor diameter of(1.36±0.31)cm.The control group underwent thoracoscopic segmentectomy,while the study group underwent 3D-CTBA precise localization before thoracoscopic segmentectomy.The operation-related indexes,serum tumor marker levels before and 7 days after surgery,changes in pulmonary function indexes before and 1 month after surgery,and incidence of complications were compared between the two groups.χ^(2) test and independent sample t test were used.Results The operation time and thoracic drainage tube removal time[(115.77±7.96)min and(3.48±0.81)d]in the study group were shorter than those in the control group[(140.05±8.77)min and(4.52±0.74)d],the intraoperative blood loss and postoperative drainage volume were less than those in the control group[(129.83±11.65)ml vs.(150.02±10.23)ml,(541.23±41.78)ml vs.(720.22±56.66)ml],and the number of lymph nodes dissected was more than that in the control group[(11.86±2.44)vs.(9.26±2.31)](all P<0.05).Seven days after surgery,the levels of CA125,CA724,and CEA in both groups were decreased compared with those before surgery,and those in the study group[(29.88±6.15)U/ml,(11.75±7.08)U/ml,and(15.55±5.67)µg/L]were lower than those in the control group[(36.78±5.42)U/ml,(18.35±6.24)U/ml,and(21.22±6.45)µg/L](all P<0.05).One month after surgery,the forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),and peak expiratory flow(PEF)in both groups were decreased compared with those before surgery,and those in the study group[(2.95±0.58)L,(1.68±0.19)L,and(4.73±0.59)L/s]were higher than those in the control group[(2.72±0.65)L,(1.50±0.33)L,and(4.50±0.57)L/s](all P<0.05).The total incidence of complications in the study group was 10.29%(7/68),which was lower than that in the control group[29.85%(20/67)],with a statistically significant difference(χ^(2)=8.067,P=0.005).Conclusion The precise positioning of 3D-CTBA in patients undergoing thoracoscopic segmentectomy for early NSCLC can reduce the levels of serum tumor markers,reduce the impact on lung function,and have fewer complications and high surgical safety.