胸腔镜肺亚叶切除术及肺叶切除术对肺癌患者的疗效  

Efficacy of Thoracoscopic Sublobectomy and Lobectomy Resection in Patients with Lung Cancer

作　　者：张宇[1] 王辉 陈晶[1] 朱勇[1] 王相臣[1] ZHANG Yu;WANG Hui;CHEN Jing;ZHU Yong;WANG Xiangchen(Department of Cardiothoracic Surgery,Puyang People’s Hospital,Puyang 457000,China)

机构地区：[1]濮阳市人民医院心胸外科,河南濮阳457000

出　　处：《河南医学研究》2023年第9期1648-1651,共4页Henan Medical Research

摘　　要：目的 探讨胸腔镜肺亚叶切除术及肺叶切除术对肺癌患者的影响,为临床治疗提供参考。方法 将濮阳市人民医院2017年3月至2019年3月收治的86例肺癌患者纳入研究,通过随机数字表法将其分为观察组与对照组,每组43例。观察组接受胸腔镜肺亚叶切除术,对照组接受胸腔镜肺叶切除术。记录并比较两组围手术期指标,检测并比较两组术前及术后7 d免疫指标(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平,检测并比较两组术前及术后7 d创伤应激指标[皮质醇(COR)、促肾上腺皮质激素(ACTH)、生长激素(GH)]水平,比较两组并发症发生情况,对患者进行为期3 a随访,记录并比较两组3 a生存情况。结果 两组手术时长组间比较差异无统计学意义(P>0.05);观察组术中出血量、镇痛药物使用量低于对照组,术后引流时长、住院时长短于对照组(P<0.05)。术后7 d,观察组CD4^(+)、CD8^(+)及对照组CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平较术前均有下降(P<0.05),同时观察组CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组(P<0.05),两组CD8^(+)水平组间比较差异无统计学意义(P>0.05)。术后7 d,观察组与对照组COR、ACTH、GH水平较术前均有上升(P<0.05),观察组COR、ACTH、GH水平低于对照组(P<0.05)。观察组并发症总发生率低于对照组(P<0.05)。经Kaplan-Meier检验两组累积生存率差异无统计学意义(χ^(2)=0.343,P=0.558)。结论 胸腔镜肺亚叶切除术能够减少肺癌患者围手术期术中出血量、镇痛药物用量,缩短术后引流时长及住院时长,并且对机体免疫及创伤应激反应的影响较小,同时具有较高安全性,且不会降低患者累积生存率,具有临床应用价值。Objective To investigate the effects of thoracoscopic sublobectomy and lobectomy resection in patients with lung cancer,and to provide reference for clinical treatment.Methods A total of 86 patients with lung cancer admitted to Puyang People’s Hospital from March 2017 to March 2019 were included in the study.They were divided into observation group and control group by random number table method,with 43 cases in each group.The observation group underwent thoracoscopic sublobectomy,and the control group underwent thoracoscopic lobectomy.Recorded and compared the perioperative indicators of the two groups,detected and compared the levels of immune indicators(CD4^(+),CD8^(+),CD4^(+)/CD8^(+))before and 7 days after operation between the two groups,detected and compared the levels of traumatic stress indicators[cortisol(COR),adrenocorticotropic hormone(ACTH),growth hormone(GH)]before operation and 7 days after operation between the two groups,compared the incidence of complications between the two groups,and followed up the patients for 3 years,the 3-year survival of the two groups was recorded and compared.Results There was no statistically significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss,amount of analgesic drugs in the observation group were lower than those in the control group,and postoperative drainage time,hospital stay in the observation group were shorter than those in the control group(P<0.05).Seven days after operation,the levels of CD4^(+)and CD8^(+)in the observation group and CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in the control group were decreased compared with those before operation(P<0.05),and the levels of CD4^(+)and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group(P<0.05).There was no statistically significant difference in CD8^(+)levels between the two groups(P>0.05).Seven days after operation,the levels of COR,ACTH and GH in the observation group and the control group were higher than those before operation(P<0.0

关 键 词：肺癌 胸腔镜 肺亚叶切除术 免疫水平 创伤应激 累积生存率 

分 类 号：R734.2[医药卫生—肿瘤]