摘要
目的对比单操作孔与三孔电视胸腔镜微创手术(VATS)治疗老年ⅡB~ⅢA期非小细胞肺癌(NSCLC)的疗效,探讨单操作孔及三孔技术的实用性。方法回顾性分析2019-06-01-2021-06-01河南科技大学第一附属医院收治的152例老年ⅡB~ⅢA期NSCLC患者临床资料,根据手术方式的不同,将采用单操作孔VATS治疗的82例患者纳入单操作孔组,采用三孔VATS治疗的70例患者纳入三孔组。比较2组患者围术期指标(切口长度、术中出血量、术后总引流量、淋巴结清除数目)、围术期并发症(气胸、肺不张、肺部感染等)、术前和术后1、2、3 d血清细胞因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平及术后1个月肺功能指标[第1秒用力呼吸容积(FEV1)、用力肺活量(FVC)]。收集以上数据,计数资料用n(%)表示,采用χ^(2)检验,计量资料用x±s表示,组间比较采用单因素协方差分析或重复测量方差分析。结果单操作孔组切口长度为(4.45±1.41)cm,短于三孔组的(6.42±1.33)cm,差异有统计学意义,t=8.095,P<0.001;单操作孔术中出血量为(140.33±28.25)mL,低于三孔组的(168.95±33.42)mL,差异有统计学意义,t=5.722,P<0.001;单操作孔术后总引流量为(890.44±189.23)mL,低于三孔组的(1310.27±229.56)mL,差异有统计学意义,t=12.359,P<0.001;单操作孔组淋巴结清除数目为(15.61±4.12)个,三孔组淋巴结清除数目为(14.99±4.03)个,2组比较差异无统计学意义,t=0.934,P=0.352。术后1个月,单操作孔组FEV1为(1.67±0.47)L,高于三孔组的(1.44±0.42)L,差异有统计学意义,F=32.213,P<0.001;单操作孔组FVC为(2.16±0.41)L,高于三孔组的(1.82±0.36)L,差异有统计学意义,F=28.046,P<0.001。单操作孔组围术期并发症总发生率为7.50%,低于三孔组的23.34%,但比较差异无统计学意义,χ^(2)=3.510,P=0.061。术后1、2和3 d时,2组患者IL-6、TNF-α与术前相比较均升高,但单操作孔组患者术后1、2和3 d,IL-6、TNF-α水平均低于三孔组,差异有统计学意义,均P<0.05。结论三孔VATS与单操作孔VATS对老年ⅡB~ⅢA期NSCLC患者具有相似的淋巴结清除效果,但单操作孔VATS术中创伤小、术后恢复快、炎性反应小,还可促进肺功能恢复,该手术方式具有较高可行性和安全性。
Objective The aim of this study was to compare the curative effects of single utility port and three port VATS in the treatment of elderly stageⅡB-ⅢA non-small cell lung cancer(NSCLC)and to explore the practicability of single utility port and three port techniques.Methods A retrospective analysis was performed on the clinical data of 152 elderly patients with stageⅡB-ⅢA NSCLC who were treated in the First Affiliated Hospital of Henan University of Science and Technology from June 1,2019 to June 1,2021.According to the different surgical methods,82 patients who received single utility port VATS were included in single utility port group,and 70 patients who underwent three port VATS were enrolled as three port group.The perioperative indicators(incision length,intraoperative blood loss,total postoperative drainage volume,the number of dissected lymph nodes),perioperative complications(pneumothorax,atelectasis,lung infection),levels of serum cytokines[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]before surgery and at 1-,2-,and 3 days after surgery and lung function indicators[forced expiratory volume in one second(FEV1),forced vital capacity(FVC)]before surgery and at 1 month after surgery were compared between the two groups.The above data were collected,and the enumeration data were represented by n(%),χ^(2)test was used and the measurement data were represented by x±s.One-way analysis of covariance or repeated measure analysis of variance was used for comparison between groups.Results The incision length in single utility port group was shorter than that in three port group(4.45±1.41)cmvs(6.42±1.33)cm,t=8.095,P<0.001,and the intraoperative blood loss was less than that in three port group(140.33±28.25)ml vs(168.95±33.42)ml,t=5.722,P<0.001,and the total drainage volume was less than that in three port group(890.44±189.23)ml vs(1310.27±229.56)ml,t=12.359,P<0.001.The number of dissected lymph nodes was(15.61±4.12)in single utility port group and(14.99±4.03)in three port group(t=0.934,P=0.352).At 1 month after surgery,FEV1 in single utility port group was(1.67±0.47)L,which was higher than(1.44±0.42)L in three port group(F=32.213,P<0.001).The FVC in single utility port group was(2.16±0.41)L,which was higher than(1.82±0.36)L in three port group(F=28.046,P<0.001).The total incidence rate of perioperative complications in single utility port group was lower than that in three port group(7.50%vs 23.34%,χ^(2)=3.510,P=0.061).At 1 day,2 days and 3 days after surgery,the levels of IL-6and TNF-αin the two groups were increased compared with those before surgery,but the levels in single utility port group at 1-,2-,and 3 days after surgery were lower than those in three port group(all P<0.05).Conclusion Three port VATS and single utility port VATS have similar lymph node dissection effect on elderly patients with stageⅡB-ⅢA NSCLC,but single utility port VATS has relatively small intraoperative trauma,rapid postoperative recovery and small inflammatory response,and it can promote the recovery of lung function.Therefore,this surgical method has high feasibility and safety.
作者
杨艳坤
焦红朵
韩亚龙
YANG Yankun;JIAO Hongduo;HAN Yalong(Department of Pulmonary Oncology,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)
出处
《社区医学杂志》
CAS
2023年第3期136-140,共5页
Journal Of Community Medicine
关键词
单操作孔
三孔电视胸腔镜微创手术
ⅡB~ⅢA期非小细胞肺癌
老年人
single utility port
three port video-assisted thoracoscopic surgery
stageⅡB-ⅢA non-small cell lung cancer
elderly
作者简介
通信作者:杨艳坤,女,河南洛阳人,主要从事食管肺肿瘤方面的研究工作。E-mail:yangyank525@163.com
