胸腔镜肺叶切除术治疗非小细胞肺癌对术后炎性因子及应激水平的影响  

Effects of thoracoscopic lobectomy on inflammatory factors and stress levels in patients with non-small cell lung cancer

作　　者：蔡杰飞 张诗杰[2] 李伟[1] 张宪[1] 李寒 Cai Jiefei;Zhang Shijie;Li Wei;Zhang Xian;Li Han(Department of Cardiothoracic Surgery, Shijiazhuang Second Hospital,Shijiazhuang 050051,China)

机构地区：[1]石家庄市第二医院心胸外科,050051 [2]北京大学第一医院胸外科,100034

出　　处：《疑难病杂志》2020年第8期808-812,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省医学科学研究重点课题计划(20170983)。

摘　　要：目的比较3D和2D胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子和应激水平的影响。方法选择2016年1月—2019年6月在石家庄市第二医院接受肺叶切除术非小细胞肺癌患者100例,按照随机数字表法分为2组各50例,3D组实施3D电视胸腔镜手术,2D组实施2D电视胸腔镜手术,患者均实施肺叶切除术。观测2组患者围术期指标,手术前后炎性因子(CRP、TNF-α、IL-6、IL-8)及应激水平(ACTH、P物质、生长激素、皮质醇)变化比较,评估近期预后及安全性指标。结果3D组患者手术时间、术中出血量、胸腔引流量、住院时间均优于2D组,差异有统计学意义(t=2.585、3.380、2.580、3.100,P均<0.01);胸腔引流时间差异无统计学意义(P>0.05)。2组术后1 d CRP、TNF-α、IL-6、IL-8均升高,术后3 d较术后1 d下降,差异有统计学意义(P<0.05)。3D组较2D组术后1 d、3 d炎性因子水平低,差异均有统计学意义(术后1 d:t=3.229、5.120、12.153、2.574,P均<0.01;术后3 d:t=8.496、4.045、2.404、12.781,P均<0.01)。2组术后ACTH、P物质、生长激素、皮质醇水平均升高,差异有统计学意义(P<0.05),2D组升高较3D组更加明显(术后1 d:t=2.343、3.195、2.692、2.258,P<0.05;术后3 d:t=2.577、11.627、2.237、2.198,P<0.05)。患者术后随访3个月,无死亡且无严重不良反应。结论与2D组相比,3D胸腔镜肺叶切除术治疗非小细胞肺癌,可以改善围术期指标,明显减轻术后炎性反应和应激反应,对机体损伤较小。Objective To compare the effects of 3D and 2D thoracoscopic lobectomy on inflammatory factors and stress levels in patients with NSCLC.Methods From January 2016 to June 2019,100 patients with non-small cell lung cancer underwent lobectomy in Shijiazhuang second hospital.According to the random number table,50 cases were divided into two groups.3D video-assisted thoracoscopy was performed in 3D group,2D video-assisted thoracoscopy was performed in 2D group,and lobectomy was performed in all patients.The perioperative indexes,inflammatory factors(CRP,TNF-α,IL-6,IL-8)and stress levels(ACTH,substance P,growth hormone,cortisol)were observed before and after operation,and the short-term prognosis and safety indexes were evaluated.Results The operation time,intraoperative bleeding volume,thoracic drainage volume and hospitalization time of 3D group were better than those of 2D group,the difference was statistically significant(t=2.585,3.380,2.580,3.100,P<0.01);there was no statistically significant difference in thoracic drainage time(P>0.05).CRP,TNF-α,IL-6 and IL-8 were all increased in the two groups on the first day after operation,and decreased on the third day after operation compared with that on the first day after operation(P<0.05).The level of inflammatory factors in 3D group was lower than that in 2D group on the 1st and 3rd day after operation,the difference was statistically significant(t=3.229,5.120,12.153,2.574,P<0.01;t=8.496,4.045,2.404,t=12.781,P<0.01).The levels of ACTH,substance P,growth hormone and cortisol in the two groups increased significantly(P<0.05).The level of ACTH,substance P,growth hormone and cortisol in the 2D group was higher than that in the 3D group(1 d:t=2.343,3.195,2.692,2.258,P<0.05;3 d:t=2.577,11.627,2.237,2.198,P<0.05).The patients were followed up for 3 months without death and serious adverse reactions.Conclusion Compared with 2D group,3D thoracoscopic lobectomy can improve the perioperative indexes,reduce the postoperative inflammatory response and stress response,and cause l

关 键 词：非小细胞肺癌 肺叶切除术 胸腔镜 炎性因子 应激 

分 类 号：R73[医药卫生—肿瘤]