单孔胸腔镜手术与三孔胸腔镜手术对老年非小细胞肺癌患者术后肿瘤微转移及应激反应影响的对比观察  

Comparative observation of the effects of single-aperture thoracoscopy and three-aperture thoracoscopy on postoperative tumor micrometastasis and stress response in elderly patients with non-small cell lung carcinoma

作　　者：程辰 张静[1] 毛启星 CHENG Chen;ZHANG Jing;MAO Qi-xing(Department of Thoracic Surgery,Jiangsu Cancer Hospital,Nanjing Jiangsu 210000,China)

机构地区：[1]江苏省肿瘤医院胸外科,江苏南京210000

出　　处：《临床和实验医学杂志》2024年第16期1711-1714,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金资助项目(编号:82002434)。

摘　　要：目的对比单孔、三孔胸腔镜手术对老年非小细胞肺癌(NSCLC)患者术后肿瘤微转移、应激反应的影响。方法回顾性选取2020年1月至2023年1月江苏省肿瘤医院收治的老年NSCLC患者90例,参考手术方式不同分为单孔组(n=45)与多孔组(n=45),单孔组予以单孔胸腔镜手术,多孔组予以三孔胸腔镜手术。比较两组患者的围手术期指标(术中出血量、手术时间、术后引流量、术后住院时间、胸管留置时间、淋巴结清扫数目)、肿瘤微转移[基质金属蛋白酶9(MMP-9)、肿瘤坏死因子受体相关蛋白(TRAP)1、钙黏附蛋白E(E-cadherin)、Krüppel样因子(KLF)4]、应激反应[前列素E2(PGE2)、5-羟色胺(5-HT)、去甲肾上腺素(NE)、皮质醇]以及术后并发症发生率。结果单孔组的术中出血量、术后引流量、住院时间及胸管留置时间分别为(36.61±22.31)mL、(971.82±301.52)mL、(6.49±2.50)d、(4.13±1.56)d,均低于多孔组[(68.18±12.18)mL、(1289.39±604.57)mL、(8.32±3.71)d、(6.42±3.17)d],差异均有统计学意义(P<0.05);两组手术时间、淋巴结清扫总数目比较,差异均无统计学意义(P>0.05)。单孔组患者术后1周的MMP-9、TRAP1、E-cadherin、KLF4水平分别为0.35±0.03、0.40±0.05、2.89±0.29、2.87±0.29,均明显低于多孔组(0.46±0.09、0.52±0.22、3.16±0.53、3.13±0.34),差异均有统计学意义(P<0.05)。单孔组患者手术次日的PGE2、5-HT、NE、皮质醇水平分别为(182.87±10.29)pg/mL、(0.68±0.05)μmol/mL、(2.85±0.28)pg/mL、(95.69±10.05)ng/mL,均明显低于多孔组[(198.98±11.79)pg/mL、(0.91±0.14)μmol/mL、(4.71±0.57)pg/mL、(116.88±18.81)ng/mL],差异均有统计学意义(P<0.05)。术后两组患者的微小并发症、重大并发症以及总并发症发生率比较,差异均无统计学意义(P>0.05)。结论对于老年NSCLC患者,与三孔胸腔镜手术相比,采用单孔胸腔镜术围手术期恢复更快,应激反应更小,肿瘤细胞微转移活跃度更加稳定,具有良好的�Objective To analyze and compare the effects of single-aperture thoracoscopy and three-aperture thoracoscopy on postoperative tumor micrometastasis and stress response in elderly patients with non-small cell lung carcinoma(NSCLC).Methods A total of 90 elderly patients with NSCLC admitted to Jiangsu Cancer Hospital from January 2020 to January 2023 were retrospectively selected.They were divided into the single-aperture group(n=45)and the multi-port group(n=45)according to different surgical methods.The single-aperture group received single-aperture thoracoscopic surgery,while the multi-port group received three-aperture thoracoscopic surgery.Perioperative indexes(intraoperative blood loss,operative time,postoperative drainage,postoperative hospital stay,chest tube indwelling time,number of lymph node dissection),tumor micrometastasis[matrix metalloproteinase 9(MMP-9),tumor necrosis factor receptor-associated protein(TRAP)1,E-cadherin,Krüppel-like factors(KLF)4],stress response[prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT),noradrenaline(NE),cortisol]and postoperative complications were compared between the two groups.Results The intraoperative blood loss,postoperative drainage volume,hospitalization time and chest tube indwelling time in the single-port group were(36.61±22.31)mL,(971.82±301.52)mL,(6.49±2.50)d and(4.13±1.56)d,respectively,which were lower than those in the multi-port group[(68.18±12.18)mL,(1289.39±604.57)mL,(8.32±3.71)d and(6.42±3.17)d],and the differences were statistically significant(P<0.05),while there were no statistically significant differences in the operative time and the total number of lymph nodes dissection between the two groups(P>0.05).The levels of MMP9,TRAP1,E-cadherin and KLF4 in the single-port group were 0.35±0.03,0.40±0.05,2.89±0.29 and 2.87±0.29,respectively,which were significantly lower than those in the multi-port group(0.46±0.09,0.52±0.22,3.16±0.53,3.13±0.34),and the differences were statistically significant(P<0.05).The levels of PGE2,5-HT,NE and cortis

关 键 词：老年人 非小细胞肺癌 单孔胸腔镜 三孔胸腔镜 应激反应 肿瘤微转移 

分 类 号：R734.2[医药卫生—肿瘤]