文章摘要
张梁,李文海,党乙,等.全胸腔镜与胸腔镜辅助小切口肺癌手术的疗效比较及对炎性因子、肺功能的影响[J].安徽医药,2023,27(11):2176-2180.
全胸腔镜与胸腔镜辅助小切口肺癌手术的疗效比较及对炎性因子、肺功能的影响
Comparison of curative effect of total thoracoscopic surgery and thoracoscopic assisted small incision lung cancer surgery and their effect on inflammatory factors and lung function
  
DOI:10.3969/j.issn.1009-6469.2023.11.012
中文关键词: 肺切除术  胸腔镜检查  胸腔镜辅助小切口手术  肺癌  炎性因子  肺功能
英文关键词: Pneumonectomy  Thoracoscopy  Thoracoscopic-assisted small incision surgery  Lung cancer  Inflammatory factors  Lung function
基金项目:陕西省重点研发计划项目( S2022-YF-YBSF-0779)
作者单位E-mail
张梁 国际医学中心医院胸腔外科陕西西安 710100  
李文海 国际医学中心医院胸腔外科陕西西安 710100  
党乙 国际医学中心医院胸腔外科陕西西安 710100  
翟恒钰 国际医学中心医院胸腔外科陕西西安 710100 kegar04@163.com 
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中文摘要:
      目的对比全胸腔镜手术( VATS)与胸腔镜辅助小切口手术( VAMT)治疗肺癌病人的疗效及对炎性因子、肺功能的影响。方法按照手术方式不同,将 2020年 2月至 2022年 1月国际医学中心医院收治的 96例早期肺癌病人分为 VATS组( n=48)和 VAMT组( n=48)。比较两组手术结果、术中指标、术后指标、疼痛应激指标、炎性因子、肺功能、血气分析指标及并发症发生情况。结果 VATS组成功接收 VATS手术的病人例数与 VAMT组成功接收 VAMT手术的病人例数比较差异无统计学意义(P>0.05)。两组手术时间及淋巴结清扫个数比较差异无统计学意义( P>0.05)VATS组术中出血量[( 168.37±39.85)mL比(193.34±46.28)mL]、术后视觉模拟评分( VAS)[(4.03±0.91)分比( 4.95±1.12)分]、,术后引流量[( 468.34±143.64)mL比( 816.39± 256.31)mL]明显低于 VAMT组( P<0.05),术后住院时间明显短于 VAMT组[(7.88±1.83)d比( 9.69±2.34)d](P<0.05)。术后,组血清去甲肾上腺素( NE)、皮质醇( Cor)、 P物质( SP)、白细胞介素 -6(IL-6)、 C反应蛋白( CRP)、肿瘤坏死因子( TNF-α)水平较两术前明显升高( P<0.05)VATS组 NE、Cor、SP、IL-6、CRP、TNF-α水平明显低于 VAMT组( P<0.05)。术后,两组用力肺活量(FVC)、第一秒用力呼气量(,FEV1)、每分钟最大通气量( MVV)、峰值呼气流速( PEF)较术前明显降低( P<0.05)VATS组 FVC、 FEV1、MVV、PEF明显高于 VAMT组( P<0.05)。术后 1周,两组病人 PaO2均较术前升高, PaCO2均较治疗前下降(均,P<0.05),两组血气分析指标比较差异无统计学意义( P>0.05)。两组术后并发症发生率差异无统计学意义( P>0.05)。结论全胸腔镜手术治疗肺癌较胸腔镜辅助小切口手术具有更明显的优势,疗效更好,疼痛应激指标和炎性因子水平更低,对肺功能影响更小,有利于病人康复。
英文摘要:
      Objective To compare the curative effect of total thoracoscopic surgery (VATS) and thoracoscopic-assisted small incision surgery (VAMT) on patients with lung cancer and their effects on inflammatory factors and lung function.Methods A total of 96 patients with early-stage lung cancer who were admitted to International Medical Center Hospital from February 2020 to January 2022were divided into VATS group (n=48) and VAMT group (n=48) according to different surgical procedures. Surgical results, intraoperative indicators, postoperative indicators, pain stress indicators, inflammatory factors, lung function, arterial blood gas analysis index andpostoperative complications were compared between the two groups.Results There was no difference between the number of patientswho successfully received VATS surgery in VATS group and the number of patients who successfully received VAMT surgery in VAMTgroup (P>0.05). The number of the lymph node dissections and the operation time of the two groups were the same (P>0.05). The intraoperative blood loss [(168.37±39.85) mL vs. (193.34±46.28) mL], postoperative drainage volume[(468.34±143.64) mL vs. (816.39± 256.31) mL] and Visual analogue scoring (VAS) [(4.03±0.91) vs. (4.95±1.12)] were significantly lower than those of the VAMT group (P <0.05), the postoperative hospital stay was significantly shorter than that of the VAMT group [(7.88±1.83) d vs. (9.69±2.34) d] (P<0.05). After operation, the levels of serum norepinephrine (NE), cortisol (Cor), substance P (SP), interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor (TNF-α) of the two groups were significantly increased than those before operation (P<0.05), and the levels of NE, Cor, SP, IL-6, CRP and TNF-α of the VATS group were significantly lower than those in the VAMT group (P<0.05). Afteroperation, the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), maximal ventilation per minute (MVV) and peak expiratory flow rate (PEF) in the two groups were significantly decreased than those before operation (P<0.05), the FVC, FEV1, MVV and PEF in the VATS group were significantly higher than those in the VAMT group (P<0.05). After operation, the level of PaO2 in both groups was significantly increased than that before operation (P<0.05), the level of PaCO2 in both groups was significantly decreased than that before operation (P<0.05), the level of PaO2 and PaCO2 between the two groups were the same (P>0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Conclusion Total thoracoscopic surgery for lung cancer has more advantages than thoracoscopic-assisted small incision surgery, with better curative effect, lowerlevels of pain stress indicators and inflammatory factors, and less impact on lung function, which is beneficial to the recovery of patients.
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