三种手术方法治疗肺癌的疗效及对肺功能的影响  

Clinical efficacy of three kinds of surgical methods and their effects on pulmonary function of patients with lung cancer

作　　者：熊秀娥[1] 徐鹏[2] 庞一雄[1] 朱琳燕[3] 

机构地区：[1]武汉科技大学附属孝感医院心胸整复科,湖北省孝感市432000 [2]武汉科技大学附属孝感医院CT室,湖北省孝感市432000 [3]鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)肿瘤内科

出　　处：《河北医药》2018年第2期208-210,214,共4页Hebei Medical Journal

基　　金：黄石市科学技术局(编号:黄科技发农【2015】3号)

摘　　要：目的分析通过腔镜肺叶切除、腔镜肺段切除及开胸肺叶切除3种术式的临床效果及其对肺功能的影响。方法筛选2015年1月至2016年12月接收的肺癌待手术患者175例为研究对象。根据患者所选择的不同治疗方案将其分为腔镜肺段切除组58例,腔镜肺叶切除组63例,开胸肺叶切除组54例。于患者术前1 d、术后7 d,术后3个月时分别检测其肺功能恢复情况[用力肺活量(FVC)、一秒用力呼气容积(FEV1)、每分最大通气(MVV)、最大呼气流速(PEF)、CO弥散因子(TLCO)],统计患者1年随访期间并发症情况。结果术前组间患者在FVC、FEV1、MVV、PEF、TLCO指标间的差异无统计学意义(P>0.05)。术后7 d及3个月时组间患者在FVC、FEV1、MVV、PEF、TLCO指标间的差异有统计学意义(P<0.05)。其中,腔镜肺段切除组患者各项指标恢复程度最高,开胸切除组患者各项指标恢复程度最低。比较患者术后随访期间并发症情况,腔镜肺段切除组患者出现肺炎3例,脓胸1例,肺不张2例,呼吸功能不全1例;腔镜肺叶切除组患者出现肺炎4例,脓胸2例,肺不张2例,呼吸功能不全2例;开胸组患者肺炎8例,脓胸3例,肺不张5例,呼吸功能不全3例,血胸2例,死亡1例。各类并发症总发生率组间比较差异有统计学意义(P<0.05)。结论腔镜肺段切除对于肺癌患者的短期术后功能的恢复明显优于腔镜肺叶切除及开胸肺叶切除术,并且可以较其他两种术式在一定程度上减少术后并发症的发生率,有利于患者提高中远期高生活质量。Objective To investigate the clinical effects of three kinds of surgical ways including thoracoscopic pulmonary lobectomy,thoracoscopic pulmonary segment resection and traditional open pulmonary lobectomy and their effects on pulmonary function of patients with lung cancer. Methods A total of 175 patients with lung cancer who received surgery in our hospital from January 2015 to December 2016 were enrolled in the study. According to different surgical methods,these patients were divided into endoscopic pulmonary segment resection group（ n = 58）,thoracoscopic pulmonary lobectomy group（ n = 63） and traditional open pulmonary lobectomy group（ n = 54）. The pulmonary function indexes including FVC,FEV1,MVV,PEF, TLCO on 1 d before operation,7 d,3 m after operation were detected, moreover,the incidence rates of complications during 1-year follow up were observed and compared among the three groups. Results Before operation,there were no significant differences in pulmonary function indexes among the three groups（ P〉0. 05）. However,there were significant differences in FVC,FEV1,MVV,PEF on 7 d,3 m after operation among the three groups（ P〈0. 05）,in which,the recovery degree of these indexes in endoscopic pulmonary segment resection group was the highest,however,which in traditional open pulmonary lobectomy group was the lowest. In the aspect of complicatins,there were 3 cases of pneumonia,1 case of empyema,2 cases of pulmonary atelectasis and 1 case of respiratory insufficiency in endoscopic pulmonary segment resection group,and there were 4 cases of pneumonia,2 cases of empyema,2 cases of pulmonary atelectasis and 2 cases of respiratory insufficiency in thoracoscopic pulmonary lobectomy group,moreover,there were 8 cases of pneumonia,3 cases of empyema,5 cases of pulmonary atelectasis,3 cases of respiratory insufficiency and 1 case of death in traditional open pulmonary lobectomy group. There was a significant difference in total incidence rate of complications among the three groups（ P〈0. 05�

关 键 词：腔镜手术 开胸手术 肺叶切除 肺段切除 

分 类 号：R734.2[医药卫生—肿瘤]