老年患者早期非小细胞肺癌胸腔镜下肺叶切除术与肺楔形切除术治疗效果比较  

Comparison of therapeutic effect of thoracoscopic lobectomy and pulmonary wedge resection on elderly patients with early-stage non-small cell lung cancer

作　　者：马志飞[1] 陈文[1] 郑琳[1] MA Zhifei;CHEN Wen;ZHENG Lin(Department of Cardiothoracic Surgery,Nanjing Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院南京市第一医院心胸外科,江苏南京210006

出　　处：《陕西医学杂志》2024年第11期1483-1486,1490,共5页Shaanxi Medical Journal

基　　金：江苏省医学重点学科(实验室)建设项目(ZDXKA2021082);南京市卫生科技发展专项资金资助项目(YKK22100)。

摘　　要：目的:比较老年患者早期非小细胞肺癌(NSCLC)胸腔镜下肺叶切除术与肺楔形切除术的治疗效果。方法:选取分别行胸腔镜下肺楔形切除术及胸腔镜下肺叶切除术的NSCLC患者为肺楔形切除组和肺叶切除组,各53例。比较两组围手术期指标、肺功能及炎症因子水平及并发症发生率。结果:肺楔形切除组术中出血量、术后引流时间及引流量、住院时间低于肺叶切除组(均P<0.05)。与术前比较,两组术后3 d、1个月及3个月第1秒用力呼气量(FEV 1)、每分钟最大通气量(MVV)、用力肺活量(FVC)呈先降低后升高趋势(均P<0.05)。与肺叶切除组比较,肺楔形切除组术后1个月和3个月FEV 1、MVV、FVC升高(均P<0.05)。与术前比较,两组术后1、3 d血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平呈先升高后降低趋势(均P<0.05)。与肺叶切除组比较,肺楔形切除组术后1、3 d血清IL-6、TNF-α水平降低(均P<0.05)。术后6个月,肺楔形切除组并发症总发生率为3.77%,与肺叶切除组11.32%比较差异无统计学意义(P>0.05)。结论:与胸腔镜下肺叶切除术相比,胸腔镜下肺楔形切除术应用于老年患者早期NSCLC能够改善围手术期指标,促进肺功能恢复,降低术后炎症反应,且安全性较好。Objective:To compare the therapeutic effect of thoracoscopic lobectomy and pulmonary wedge resection in the treatment of early-stage non-small cell lung cancer(NSCLC)in elderly patients.Methods:NSCLC patients who underwent wedge resection and lobectomy were selected as wedge resection group and lobectomy group,with 53 cases in each group.The two groups were compared in terms of perioperative indicators,pulmonary function indicators,levels of inflammatory factors and incidence rates of postoperative complications.Results:The amount of intraoperative bleeding,postoperative drainage time and volume,and hospital stay in the pulmonary wedge resection group were less or shorter than those in the lobectomy group(all P<0.05).Compared with preoperative levels,the forced expiratory volume in one second(FEV 1),maximum ventilation volume(MVV),and forced vital capacity(FVC)in both groups showed a trend of initially decreasing and then increasing at 3 days,1 month,and 3 months postoperatively(all P<0.05).Compared with the lobectomy group,the FEV 1,MVV and FVC in the pulmonary wedge resection group were enhanced at 1 month and 3 months postoperatively(all P<0.05).Compared with preoperative levels,the levels of serum IL-6 and TNF-αin both groups showed an initial increase followed by a decrease at 1 and 3 days postoperatively(all P<0.05).Compared with the lobectomy group,serum IL-6 and TNF-αlevels in the pulmonary wedge resection group were reduced at 1 and 3 days postoperatively(all P<0.05).The total incidence rate of complications at 6 months postoperatively in the pulmonary wedge resection group was 3.77%,which was not statistically different from 11.32%in the lobectomy group(P>0.05).Conclusion:Compared with thoracoscopic lobectomy,thoracoscopic pulmonary wedge resection is more beneficial to improving perioperative indicators,promoting pulmonary function recovery,and reducing postoperative inflammatory response in elderly patients with early-stage NSCLC,and it has better safety.

关 键 词：非小细胞肺癌 胸腔镜下肺叶切除术 胸腔镜下肺楔形切除术 围手术期 肺功能 炎症因子 

分 类 号：R734.2[医药卫生—肿瘤]