双孔胸腔镜肺叶切除联合系统性纵隔淋巴结清扫术对肺癌患者疼痛相关因子水平及预后的影响  

Effect of Double-port Thoracoscopic Lobectomy Combined with Systematic Mediastinal Lymph Node Dissection on Pain-related Factors and Prognosis in Patients with Lung Cancer

作　　者：王家鹏 马丹 曹蔚 李祥 李德刚 孔令华 WANG Jiapeng;MA Dan;CAO Wei;LI Xiang;LI Degang;KONG Linghua(Department of Thoracic and Cardiovascular Surgery,Zhaotong First People's Hospital,Zhaotong,Yunnan Province,657000 China)

机构地区：[1]昭通市第一人民医院胸心外科,云南昭通657000

出　　处：《世界复合医学》2022年第3期12-16,共5页World Journal of Complex Medicine

摘　　要：目的 探讨双孔胸腔镜肺叶切除联合系统性纵隔淋巴结清扫术对肺癌患者疼痛相关因子水平及预后的影响。方法选取2019年1月—2021年1月该院收治的肺癌患者86例,依据随机数表法将其分为对照组和观察组,各43例。给予观察组双孔胸腔镜肺叶切除联合系统性纵膈淋巴结清扫,给予对照组三孔胸腔镜肺叶切除联合系统性纵膈淋巴结清扫,两组均观察至出院,并随访1个月。对比两组围术期指标,术前、术后24 h疼痛因子水平,术后12、24、72 hVAS评分,术后并发症发生情况。结果 观察组的住院时间、胸腔引流时间均短于对照组,手术时间则长于对照组,淋巴结清扫数目则低于对照组,术中失血量则少于对照组,差异有统计学意义(t=4.296、6.443、3.937、2.605、2.832,P<0.05)。术前,观察组NE (56.93±10.32)ng/L、SP (3.31±0.65)μg/mL、Cor (49.89±12.36)ng/mL、PGE2(76.54±9.89)pg/mL,对照组NE (56.84±10.26)ng/L、SP(3.36±0.66)μg/mL、Cor(49.66±12.28)ng/mL、PGE2(76.89±9.87)pg/mL,术后24 h两组血清NE、SP、Cor、PGE2水平均升高,差异有统计学意义(P<0.05);且观察组NE(145.62±12.37)ng/L、SP(7.41±1.32)μg/mL、Cor(132.89±15.47)ng/mL、PGE2 (155.21±24.11)pg/mL较对照组NE (176.54±23.11)ng/L、SP (9.64±1.56)μg/mL、Cor (152.06±16.49)ng/mL、PGE2(183.39±30.26)pg/mL更低,差异有统计学意义(t=7.735、7.156、5.560、4.776,P<0.05)。与术后12 h相比,术后24、72 h两组VAS评分均降低,且观察组较对照组更低,差异有统计学意义(t=4.438、5.265、9.064,P<0.05)。观察组的并发症总发生率(6.99%)低于对照组(23.28%),差异有统计学意义(χ^(2)=4.440,P<0.05)。结论 双孔胸腔镜肺叶切除联合系统性纵隔淋巴结清扫术可减少肺癌患者术后创伤及并发症的出现,对患者的术后恢复有促进作用,还可减少患者疼痛状况。Objective To investigate the effect of double-port thoracoscopic lobectomy combined with systematic mediastinal lymph node dissection on the levels of pain-related factors and prognosis in patients with lung cancer. Methods 86 patients with lung cancer treated in the hospital from January 2019 to January 2021 were randomly divided into control group and observation group, with 43 cases in each group. The observation group was given double hole thoracoscopic lobectomy combined with systematic mediastinal lymph node dissection, and the control group was given three hole thoracoscopic lobectomy combined with systematic mediastinal lymph node dissection. Both groups were observed until discharge and followed up for 1month. The perioperative indexes, pain factor level 24 h before and after operation, VAS scores 12 h, 24 h and 72 h after operation, and the incidence of postoperative complications were compared between the two groups. Results The hospitalization time and thoracic drainage time of the observation group were shorter than those of the control group, the operation time was longer than that of the control group, the number of lymph node dissection was lower than that of the control group, and the intraoperative blood loss was less than those of the control group, and the difference was statistically significant(t=4.296, 6.443, 3.937,2.605, 2.832, P<0.05). Before operation, NE(56.93±10.32) ng/L, SP(3.31±0.65) μg/mL, Cor(49.89±12.36) ng/mL, and PGE2(76.54±9.89) pg/mL in the observation group;NE(56.84±10.26) ng/L, SP(3.36 ±0.66) μg/mL, Cor(49.66±12.28) ng/mL, and PGE2(76.89 ±9.87) pg/mL found in the control group, the serum levels of NE, SP, Cor and PGE2 all increased 24 h after surgery, the difference was statistically significant(P<0.05). Add the concentrations of NE(145.62±12.37) ng/L, SP(7.41±1.32) μg/mL, Cor(132.89±15.47) ng/mL, PGE2(155.21±24.11) pg/mL in the observation group were lower than those of NE(176.54±23.11) ng/L, SP(9.64±1.56) μ g/mL, Cor(152.06±16.49) ng/mL and PGE2(183.39±

关 键 词：肺癌 双孔 胸腔镜肺叶切除术 纵隔淋巴结清扫术 疼痛 

分 类 号：R4[医药卫生—临床医学]