单孔与传统三孔胸腔镜手术治疗肺癌对患者术后应激反应的影响  

Effect of uniportal and traditional three-port video-assisted thoracoscopic surgery on the postoperative stress response in lung cancer patients

作　　者：谢建将[1] 陈敏东[1] 陈曲海[1] 陈文广[1] 梁登峰[1] 徐子迅[1] 白文杰[1] 

机构地区：[1]广州市第一人民医院胸外科,广东广州510180

出　　处：《中国临床研究》2018年第1期84-87,共4页Chinese Journal of Clinical Research

摘　　要：目的分析比较单孔与传统三孔胸腔镜手术治疗肺癌对患者术后应激反应的影响,以进一步探讨单孔胸腔镜技术在肺癌患者外科手术治疗中的临床应用价值。方法选择2015年3月至2017年3月胸外科收治的行胸腔镜肺叶切除及系统性淋巴结清扫的肺癌患者186例作为研究对象,其中单孔胸腔镜组(单孔组)102例,三孔胸腔镜组(三孔组)84例,比较两组患者围术期情况、术后应激反应指标和炎性反应指标的变化情况。结果单孔组患者的手术时间、术中出血量、淋巴结清扫数目与三孔组相比,差异均无统计学意义(P均>0.05);但单孔组患者的术后胸腔管留置时间明显短于三孔组[(4.3±1.3)d vs(5.9±1.7)d,P<0.05]。术后第1天和第7天,单孔组患者的皮质醇、生长激素和和前列腺素E2(PGE2)水平均明显低于三孔组(P均<0.05),但两组的促肾上腺皮质激素(ACTH)水平相比差异无统计学意义(P均>0.05);单孔组患者的C反应蛋白(CRP)、降钙素原(PCT)和白细胞介素(IL)-6水平也明显低于三孔组(P均<0.05),差异均具有统计学意义(P均<0.05)。结论单孔胸腔镜手术治疗肺癌,较传统三孔胸腔镜手术更有利于改善患者围术期指标,减轻机体术后的应激反应和炎症反应,促进患者术后的康复。Objective To compare the effect of uniportal and traditional three-port video-assisted thoracoscopic surgery （VATS） on the postoperative stress response in lung cancer patients. Methods The 186 lung cancer patients who received lobectomy and systematic lymph node dissection under VATS from March 2015 to March 2017 were selected as research object, and all the patients were divided into uniportal VATS group （uniportal group, n = 102） and three-port VATS group （ three-port group, n = 84 ）. The peri-operative situation （ such as operation time, intraoperative blood loss, postoperative thoracic canal retention time and the number of lymph nodes dissection）, the level of stress response indexes [ such as cortisol, growth hormone, adrenocorticotropin （ACTH） and prostaglandin E2 （PGE2 ）], and the level of inflammatory response indexes [ such as C reactive protein （ CRP）, calcitonin （PCT） and interleukin （ IL）-6 ] were compared in two groups before and after the surgery. Results There was no difference between two groups in operation time,intraoperative blood loss, and the number of lymph nodes dissection （ all P 〉 0.05 ） , while the postoperative thoracic canal retention time in uniportal group was longer than that in three-port group [ （4.3 ± 1.3 ） d vs （ 5.9 ± 1.7 ） d, P 〈 0. 05 ]. The level of cortisol, growth hormone, and PGE2 in uniportal group were lower than those in three-port group at 1 st and 7th day after the operation （ all P 〈 0. 05 ）, while there was no difference between two groups in level of ACTH （ all P 〉 0. 05 ）. The level of CRP, PCT, and IL-6 in uniportal group were lower than those in three-port group at 1 st and 7th day after the operation （all P 〈 0. 05 ）. Conclusion Compared to traditional three-port VATS, the uniportal VATS has a better effect in improving peri-operation situation, and reducing postoperative stress response and inflammation reaction, which could promote patient＇s recovery.

关 键 词：胸腔镜手术 单孔 三孔 肺癌 应激反应 炎性反应 

分 类 号：R734.2[医药卫生—肿瘤]