Thoracoscopic radical resection of lung cancerversus conventional thoracotomy in the treatment of lung cancer
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摘要:目的 比较胸腔镜下肺癌根治术与常规开胸手术治疗肺癌的临床疗效。方法 选取120例肺癌患者，随机分为2组各60例, A组采取胸腔镜下肺癌根治术, B组采取常规开胸手术，比较2组术前与术后7 d肺功能、免疫炎症指标，比较2组手术指标、术后恢复情况及并发症情况。结果 术后7 d, 2组用力肺活量(FVC)、最大通气量(MVV)、第1秒用力肺活量(FEV1)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、CD4+/CD8+均显著降低(P < 0.05), C反应蛋白(CRP)水平显著升高(P < 0.05), B组降低与升高程度更为显著(P < 0.05)。2组淋巴结清扫数比较无显著差异(P>0.05)。A组手术时间、术中出血量、术后引流量均显著优于B组(P < 0.05), 置管时间、住院时间显著短于B组(P < 0.05)。A组术后并发症总发生率为6.67%, 显著低于B组的21.67% (P < 0.05)。结论 相较于常规开胸手术, 胸腔镜下肺癌根治术创伤小，患者术后炎症反应轻，并发症少，对机体免疫功能与肺功能影响小，可缩短康复进程。Abstract:Objective To compare the clinical efficacy of thoracoscopic radical resection of lung cancer and conventional thoracotomy in the treatment of lung cancer.Methods A total of 120 patients with lung cancer were randomly divided into two groups, with 60 cases in each group. Group A underwent thoracoscopic radical resection of lung cancer, while group B underwent conventional thoracotomy. The pulmonary function and immune inflammation indexes before and 7 days after operation were compared between the two groups. The operation indexes, postoperative recovery and complications were compared between the two groups.Results Seven days after operation, forced vital capacity (FVC), maximum ventilation volume (MVV), forced expiratory volume in one second (FEV1), immunoglobulin M (IgM), immunoglobulin G (IgG), immunoglobulin A (IgA) and CD4+/CD8+ decreased significantly in both groups (P < 0.05), CRP level increased significantly (P < 0.05), and the decreased and increased degrees of indexes above in group B were significantly greater than those in group A (P < 0.05). There was no significant difference in the number of lymph node dissection between the two groups (P>0.05). The operation time, intra-operative bleeding volume and postoperative drainage volume of group A were significantly better than those of group B (P < 0.05), while the indwelling time and hospitalization time of group A were significantly shorter than those of group B (P < 0.05). The total incidence rate of postoperative complications in group A was 6.67%, which was significantly lower than 21.67% in group B (P < 0.05).Conclusion Comparedwith conventional thoracotomy, thoracoscopic radical resection of lung cancer has advantages such as less trauma, less inflammatory reaction and fewer complications, less impact on immune function and lung function, and shorter rehabilitation process.
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Keywords:
- thoracoscopy /
- thoracotomy /
- lung cancer /
- efficacy /
- indicators of lung function
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表 1 2组手术前后肺功能指标比较(x±s)
组别 时点 FVC/L MVV/L FEV1/L A组(n=60) 术前 2.60±0.28 78.12±8.03 2.15±0.23 术后7 d 2.03±0.25*# 54.36±5.94*# 1.62±0.18*# B组(n=60) 术前 2.63±0.31 78.09±8.00 2.12±0.21 术后7 d 1.70±0.19* 46.12±4.98* 1.23±0.16* FVC: 用力肺活量; MVV: 最大通气量; FEV1: 第1秒用力肺活量。与术前比较, *P < 0.05; 与B组比较, #P < 0.05。 
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表 2 2组手术前后免疫炎症指标比较(x±s)
组别 时点 IgM/(g/L) IgG/(g/L) IgA/(g/L) CD4+/CD8+ CRP/(mg/L) A组(n=60) 术前 1.38±0.15 14.36±1.57 2.12±0.28 1.82±0.19 7.02±0.76 术后7d 1.30±0.14*# 12.13±1.36*# 1.96±0.23*# 1.09±0.12*# 36.14±3.87*# B组(n=60) 术前 1.36±0.14 14.40±1.59 2.15±0.30 1.85±0.21 6.98±0.74 术后7d 1.14±0.13* 10.52±1.14* 1.76±0.20* 0.85±0.09* 50.43±5.28* IgA: 免疫球蛋白A; IgM: 免疫球蛋白M; IgG: 免疫球蛋白G; CRP: C反应蛋白。与术前比较, *P < 0.05; 与B组比较, #P < 0.05。
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表 3 2组手术指标比较(x±s)
组别 n 手术时间/min 术中出血量/mL 淋巴结清扫数/个 A组 60 100.35±12.47* 151.27±18.92* 3.12±0.34 B组 60 136.28±17.45 223.69±23.78 3.05±0.32 与B组比较, *P < 0.05。
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表 4 2组术后恢复情况比较(x±s)
组别 n 引流量/mL 置管时间/d 住院时间/d A组 60 713.68±78.54* 5.63±0.58* 7.65±0.79* B组 60 1 196.37±120.35 8.74±0.92 13.52±1.47 与B组比较, *P < 0.05。
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表 5 2组术后并发症情况比较[n(%)]
组别 n 切口感染 肺感染 肺不张 出血 气胸 乳糜胸 胸腔积液 总计 A组 60 1(1.67) 0 0 1(1.67) 2(3.33) 0 0 4(6.67)* B组 60 2(3.33) 1(1.67) 1(1.67) 3(5.00) 4(6.67) 1(1.67) 1(1.67) 13(21.67) 与B组比较, *P < 0.05。
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