单孔胸腔镜下肺段及肺叶切除术治疗早期肺癌的临床效果

Clinical efficacy of single-incision thoracoscopic segmentectomy and lobectomy for early-stage lung cancer

目的探讨单孔胸腔镜下肺段及肺叶切除术治疗早期肺癌的临床效果及对患者手术指标及肺功能的影响。方法回顾性分析新疆医科大学第八附属医院于2020年9月—2023年3月收治的106例早期肺癌患者的临床资料,根据手术方式不同分为肺段切除组(n=53)与肺叶切除组(n=53)。2组患者均采用单孔胸腔镜进行治疗,比较2组患者手术指标、肺功能指标、免疫功能指标以及并发症发生情况。结果肺段切除组患者术中出血量、术后引流量少于肺叶切除组,术后住院时间短于肺叶切除组,手术时间长于肺叶切除组,差异均有统计学意义(P<0.05);2组患者淋巴结清扫枚数、淋巴结清扫站数比较,差异均无统计学意义(P>0.05)。2组患者术前第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)水平比较,差异均无统计学意义(P>0.05);2组患者术后1个月的FEV_(1)、FVC水平均低于术前,但肺段切除组高于肺叶切除组,差异均有统计学意义(P<0.05)。2组患者术前CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平比较,差异均无统计学意义(P>0.05);2组患者术后3 d的CD3^(+)、CD4^(+)水平均高于术前,CD4^(+)/CD8^(+)水平低于术前,且肺段切除组CD3^(+)、CD4^(+)水平高于肺叶切除组,差异均有统计学意义(P<0.05);2组患者术后3 d的CD4^(+)/CD8^(+)水平比较,差异无统计学意义(P>0.05)。肺叶切除组与肺段切除组患者术后住院期间并发症发生率分别为13.21%和7.55%,差异无统计学意义(P<0.05)。结论与单孔胸腔镜下肺叶切除术治疗早期肺癌相比,单孔胸腔镜下肺段切除术可显著减少患者术中出血量、术后引流量,缩短术后住院时间,疗效显著,同时还有助于改善患者术后肺功能与免疫功能,且安全性较高。

Objective To investigate the clinical efficacy of single-incision thoracoscopic segmentectomy and lobectomy for early-stage lung cancer and its impact on surgical indicators and lung function in patients.Methods A retrospective analysis was conducted on the clinical data of 106 patients with early-stage lung cancer admitted to the Eighth Affiliated Hospital of Xinjiang Medical University from September 2020 to March 2023.The patients were assigned to the segmentectomy group(n=53)and the lobectomy group(n=53)following the different surgical methods.Both groups of patients were treated with single-incision thoracoscopic surgery.The surgical indicators,lung function indicators,immune function indicators,and incidence of complications were compared between the two groups.Results The intraoperative blood loss and postoperative drainage volume in the segmentectomy group were lower than those in the lobectomy group;while the length of hospital stay was shorter in the segmentectomy group;the operation time was longer in the segmentectomy group,all with statistical significance(P<0.05).No significant difference was observed in the number of lymph node dissections and lymph node stations between the two groups(P>0.05).No significant difference was found in the forced expiratory volume in 1 second(FEV_(1))and forced vital capacity(FVC)levels before surgery between the two groups(P>0.05).The FEV_(1)and FVC levels of both groups were lower than before surgery at 1 month after surgery,but the segmentectomy group was higher than the lobectomy group,and the differences were statistically significant(P<0.05).No significant difference was found in the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+) before surgery between the two groups(P>0.05).The levels of CD3^(+) and CD4^(+) were higher,and the level of CD4^(+)/CD8^(+) was lower than before surgery at 3 days after surgery in both groups.The CD3^(+) and CD4^(+) levels in the segmentectomy group were significantly higher than those in the lobectomy group(P<0.05).No significant difference was found in the CD4^(+)/CD8^(+)levels at 3 days after surgery between the two groups(P>0.05).The difference in the incidence of complications during hospitalization between the lobectomy group and the segmentectomy group was not statistically significant(13.21%vs.7.55%;P>0.05).Conclusion Compared with singleincision thoracoscopic lobectomy for early-stage lung cancer,single-incision thoracoscopic segmentectomy can significantly reduce intraoperative blood loss and postoperative drainage volume,shorten the length of hospital stay,and achieve marked therapeutic effects.It also promotes postoperative lung function and immune function in patients,with a high safety profile.