信迪利单抗联合紫杉醇、顺铂化疗方案治疗后应用胸腔镜肺癌根治术的价值

The value of applying thoracoscopic radical resection of lung cancer after treatment with sintilimab combined with paclitaxel and cisplatin chemotherapy regimen

目的探讨肺癌患者接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗后采用胸腔镜肺癌根治术的价值。方法104例肺癌患者,以随机数字表法分成研究组(n=52)与对照组(n=52)。两组均接受信迪利单抗联合紫杉醇、顺铂化疗方案治疗,对照组采用开胸肺癌根治术治疗,研究组采用胸腔镜肺癌根治术治疗。比较两组围手术期指标(手术时间、留置引流管时间、住院时间、术中出血量、清扫淋巴结数),肺功能指标[肺活量(VC)、第1秒用力呼气容积(FEV1)、最大通气量(MVV)],疼痛介质[P物质(SP)、前列腺素E2(PGE2)],应激反应[谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)],炎症因子[白细胞介素(IL)-6、IL-17],生命质量[生命质量测定量表(QLQ-C30)评分],并发症发生情况。结果与对照组的(145.13±1.57)min、(6.18±1.41)d、(16.57±1.68)d、(120.06±1.91)ml、(23.57±1.33)个比较,研究组手术时间(127.83±1.52)min、留置引流管时间(3.41±1.35)d、住院时间(12.57±1.51)d更短,术中出血量(108.92±1.65)ml更少,清扫淋巴结数(27.92±1.55)个更多(P<0.05)。两组术后7 d的VC、FEV1、MVV高于本组术前,研究组术后7 d的VC(2.72±0.58)L、FEV1(2.05±0.75)L、MVV(71.95±5.89)L/min高于对照组的(2.29±0.56)L、(1.76±0.61)L、(65.88±4.52)L/min(P<0.05)。两组术后7 d的SP、PGE2水平高于本组术前,研究组术后7 d的SP(7.78±1.34)μg/ml、PGE2(174.93±4.31)ng/L低于对照组的(9.45±1.56)μg/ml、(192.87±5.24)ng/L(P<0.05)。两组术后7 d的SOD、GSH-Px水平低于本组术前,研究组术后7 d的SOD(149.82±4.37)U/ml、GSH-Px(71.63±3.25)U/ml高于对照组的(112.54±4.12)、(58.71±3.71)U/ml(P<0.05)。两组术后1个月的IL-6、IL-17水平低于本组术前,研究组术后1个月的IL-6(6.52±0.86)pg/ml、IL-17(5.12±1.24)pg/ml低于对照组的(7.13±1.03)、(6.45±1.73)pg/ml(P<0.05)。两组术后1个月QLQ-C30评分高于本组术前,研究组术后1个月QLQ-C30评分(72.64±3.92)分高于对照组的(64.81±3.76)分(P<0.05)。研究组术后并发症发生率为7.69%(4/52),低于对照组的25.00%(13/52)(P<0.05)。结论信迪利单抗联合紫杉醇、顺铂化疗方案治疗后应用胸腔镜肺癌根治术治疗肺癌患者,能够改善围手术期指标,促进其肺功能提高,减少疼痛介质分泌,降低应激反应及炎症因子水平,改善生命质量,减少术后并发症发生。

Objective To explore the value of applying thoracoscopic radical resection of lung cancer after treatment with sintilimab combined with paclitaxel and cisplatin chemotherapy regimen.Methods A total of 104 cases of lung cancer patients were divided into the study group(n=52)and the control group(n=52)by random number table method.Both groups were treated with sintilimab combined with paclitaxel and cisplatin chemotherapy regimen.After which,the control group received open surgery for lung cancer,the study group received thoracoscopic radical resection of lung cancer.Both groups were compared in terms of perioperative indicators(operation time,retention time of the drainage tube,hospitalization time,intraoperative blood loss,number of lymph node dissection),lung function indicators[vital capacity(VC),forced expiratory volume in one second(FEV1),maximum ventilation volume(MVV)],pain mediators[substance P(SP),prostaglandin E2(PGE2)],stress response[glutathione peroxidase(GSH-Px),superoxide dismutase(SOD)],inflammatory factors[interleukin-6(IL),IL-17],quality of life[quality of life questionnaire-core 30(QLQ-C30)score],and postoperative complications.Results Compared with(145.13±1.57)min,(6.18±1.41)d,(16.57±1.68)d,(120.06±1.91)ml,(23.57±1.33)nodes in the control group,the study group had shorter operation time of(127.83±1.52)min,retention time of drainage tube of(3.41±1.35)d and hospitalization time of(12.57±1.51)d,less intraoperative blood loss of(108.92±1.65)ml,and more number of lymph nodes dissection of(27.92±1.55) nodes (P<0.05). 7 d after surgery, the levels of VC, FEV1 and MVV in the two groups were higher than those before surgery in this group;the study group had VC of (2.72±0.58) L, FEV1 of (2.05±0.75) L and MVV of (71.95±5.89) L/min, which were higher than (2.29±0.56) L, (1.76±0.61) L and (65.88±4.52) L/min in the control group (P<0.05). 7 d after surgery, the levels of SP and PGE2 in the two groups were higher than those before surgery in this group;the study group had SP of (7.78±1.34) μg/ml and PGE2 of (174.93±4.31) ng/L, which were lower than (9.45±1.56) μg/ml and (192.87±5.24) ng/L in the control group (P<0.05). 7 d after surgery, SOD and GSH-Px levels in the two groups were lower than those before surgery in this group;the study group had SOD of (149.82±4.37) U/ml and GSH-Px of (71.63±3.25) U/ml, which were higher than (112.54±4.12) and (58.71±3.71) U/ml in the control group (P<0.05). 1 month after surgery, the levels of IL-6 and IL-17 in the two groups were lower than those before surgery in this group;the study group had IL-6 of (6.52±0.86) pg/ml and IL-17 of (5.12±1.24) pg/ml, which were lower than (7.13±1.03) and (6.45±1.73) pg/ml in the control group (P<0.05). 1 month after surgery, QLQ-C30 score of the two groups was higher than that before surgery in this group, and the QLQ-C30 score of (72.64±3.92) points in the study group was higher than (64.81±3.76) points in the control group (P<0.05). The incidence of postoperative complications in the study group was 7.69% (4/52), which was lower than 25.00% (13/52) in the control group (P<0.05). Conclusion The application of thoracoscopic radical resection of lung cancer after treatment with sintilimab combined with paclitaxel and cisplatin chemotherapy regimen can improve the perioperative indicators, promote the improvement of their lung function, reduce the secretion of pain mediators, lower the level of stress response and inflammatory factors, improve the quality of life, and reduce the occurrence of postoperative complications.