两种肺叶切除术式对Ⅰ～Ⅱ期非小细胞肺癌患者围术期临床指标、炎症程度及并发症的影响

Effects of two kinds of pulmonary lobectomy on perioperative clinical indexes,inflammatory reaction degree and postoperative complications of patients with non small cell lung cancer in stageⅠ～Ⅱ

目的探讨传统开胸和完全电视胸腔镜肺叶切除术式对Ⅰ~Ⅱ期非小细胞肺癌患者围手术期临床指标、炎性反应程度及术后并发症的影响。方法选取2011年2月至2015年2月收治Ⅰ~Ⅱ期非小细胞肺癌患者共140例,以随机分组法分为开胸组和胸腔镜组,每组70例。分别采用传统开胸和完全电视胸腔镜肺叶切除术式治疗,比较2组患者围手术期临床指标,术后VAS评分、手术前后CRP水平及术后并发症发生率等。结果胸腔镜组患者术中出血量、胸腔引流时间、下床活动时间及住院时间均显著优于开胸组(P<0.05);2组患者手术时间、淋巴结清扫个数及淋巴结清扫组数比较差异无统计学意义(P>0.05);胸腔镜组患者术后1 d、3 d及30 d VAS评分均显著低于开胸组(P<0.05);胸腔镜组患者术后1 d和3 d CRP水平均显著低于开胸组、术前(P<0.05);胸腔镜组患者术后并发症发生率显著低于开胸组(P<0.05)。结论与传统开胸肺叶切除术式相比,完全电视胸腔镜肺叶切除术式对Ⅰ~Ⅱ期非小细胞肺癌可有效降低术中创伤程度,加快机体康复进程,缓解术后疼痛,减轻炎性反应水平,并有助于预防术后并发症发生。

Objective To observe and compare the effects of traditional thoracotomy and complete video-assisted thoracoscopic surgery( VATS) pulmonary lobectomy on perioperative clinical indexes,inflammatory reaction degree and postoperative complications of patients with non small cell lung cancer( NSCLC) in stage Ⅰ ~ Ⅱ. Methods One hundred and forty patients with NSCLC in stage Ⅰ ~ Ⅱ who were admitted and treated in our hospital from February 2011 to February2015 were randomly divided into two groups: thoracotomy group( n = 70) and VATS group( n = 70). The patients in thoracotomy group were treated by traditional thoracotomy,however,the patients in VATS group were treated by complete VATS pulmonary lobectomy. The perioperative clinical indexes,VAS scoring after operation,CRP levels before and after operation and postoperative complications were observed and compared between two groups. Results The intraoperative hemorrhage volume,chest drainage time,out-of-bed activity time and length of staying in hospital in VATS group were superior to those in thoracotomy group( P < 0. 05). However there were no significant differences in operation time,group number of lymph node dissection between 2 groups( P < 0. 05). The VAS scores on 1d,3d and 30 d after operation in VATS group were significantly lower than those in thoracotomy group( P < 0. 05). The levels of CRP on 1d and 3d after operation in VATS group were significantly lower than those in thoracotomy group( P < 0. 05). The incidence of postoperative complications in VATS group was significantly lower than that in thoracotomy group( P < 0. 05). Conclusion As compared with traditional thoracotomy pulmonary lobectomy,the complete VATS pulmonary lobectomy can decrease the injury degree of operation in patients with NSCLC in stage Ⅰ ~ Ⅱ,and can promote rehabilitation of organism,relieve postoperative pain,alleviate inflammatory reaction degree,moreover,which is helpful to prevent occurrence of postoperative complications.