摘要
目的分析三维重建技术指导下单孔胸腔镜肺楔形切除术治疗≤2 cm肺磨玻璃结节(pulmonary ground glass nodules,PGGN)的疗效。方法选取2021年1月至2024年6月我院接受手术治疗的≤2 cm肺磨玻璃结节患者69例,实施单孔胸腔镜下肺楔形切除术32例为对照组,三维重建技术指导下实施单孔胸腔镜下肺楔形切除术37例为观察组。比较两组的手术指标、应激指标[皮质醇、去甲肾上腺素及热应激蛋白(heat stress protein,HSP)70]、术后肺功能[第1 s用力呼气容积(forced expiratory volume in one second,FEV_(1))、最大通气量(maximal ventilatory volume,MVV)及残气量]、术后疼痛程度及并发症发生情况。结果观察组手术时间(96.32±17.08)min、术中出血量(72.89±16.03)ml、术后24 h胸腔引流量(132.06±25.04)ml、胸腔引流管留置时间(2.04±0.56)d短于对照组(112.14±16.53)min、(90.41±17.85)ml、(171.29±24.3)ml、(3.12±0.71)d(P<0.05)。术后,两组血清皮质醇、去甲肾上腺素、HSP70较术前升高,观察组(172.63±35.71)ng/ml、(168.53±32.06)ng/L、(30.25±5.78)ng/ml低于对照组(201.98±32.46)ng/ml、(191.83±30.54)ng/L、(33.06±5.21)ng/ml(P<0.05)。术后1 d、术后72 h、术后1周,两组疼痛程度评分下降,观察组(4.06±0.31)分、(3.76±0.25)分、(3.01±0.26)分低于对照组(4.53±0.28)分、(4.09±0.32)分、(3.35±0.28)分(P<0.05)。术后,两组FEV_(1)、MVV降低,观察组(1.53±0.17)L、(60.53±5.17)L/min高于对照组(1.44±0.18)L、(56.12±6.82)L/min(P<0.05);两组残气量升高,观察组(1.64±0.37)L低于对照组(1.81±0.32)L(P<0.05)。观察组术后并发症6例(16.22%)低于对照组8例(25.00%),差异无统计学意义(P>0.05)。观察组37例中生存32例(86.49%),死亡5例(13.51%),对照组32例中生存21例(65.63%),死亡11例(34.37%),两组比较(P<0.05)。结论三维重建技术指导下单孔胸腔镜肺楔形切除术治疗≤2 cm肺磨玻璃结节,可缩短手术时间及术后恢复时间减少应激反应,减小术后肺功能损害及术后并发症的发生。
Objective To explore the effectiveness of using 3D reconstruction technology to guide single port thoracoscopic wedge resection for the treatment of pulmonary ground glass nodules≤2 cm.Methods A total of 69 patients with ground glass nodules measuring≤2 cm,who received surgical treatment in hospitals between January 2021 and June 2024,were enrolled in the study.These patients were divided into two groups based on the treatment method:37 patients in the observation group and 32 patients in the control group.The control group underwent single port thoracoscopic wedge resection,while the observation group underwent single port thoracoscopic wedge resection under the guidance of three-dimensional reconstruction technology.Compare the surgical indicators,stress indicators[cortisol,norepinephrine,and heat stress protein(HSP)70],postoperative lung function[forced expiratory volume in the first second(FEV_(1)),maximum ventilation volume(MVV),and residual gas volume],postoperative pain level,and incidence of complications between the two groups.Results The observation group had shorter surgical time,intraoperative blood loss,postoperative 24-hour chest drainage volume,and chest drainage tube retention time compared to the control group(P<0.05).After surgery,serum cortisol,norepinephrine,and HSP70 levels increased in both groups compared to preoperative levels,with the observation group being lower than the control group(P<0.05).On postoperative day 1,72 hours,and 1 week,the pain scores of both groups gradually decreased(P<0.05),with the observation group being lower than the control group(P<0.05).After surgery,FEV1 and MVV decreased in both groups,with the observation group being higher than the control group(P<0.05);The residual gas volume of both groups increased,and the observation group was lower than the control group(P<0.05).On postoperative day 1,72 hours,and 1 week,the pain scores of both groups gradually decreased(P<0.05),with the observation group being lower than the control group(P<0.05).There was no statistically significant difference in the total incidence of pleural effusion,pulmonary leakage,subcutaneous hematoma,and pneumothorax between the two groups(P>0.05).The 1-year cumulative survival rate of two groups has statistically significant.Conclusion Guided by three-dimensional reconstruction technology,single port thoracoscopic wedge resection is used to treat pulmonary ground glass nodules≤2 cm,which helps to shorten the surgical time and postoperative recovery time less traumatic stress,reduce postoperative lung function damage,and minimize the occurrence of postoperative complications.
作者
罗强
魏亮
陈盈盈
王云
Luo Qiang;Wei Liang;Chen Yingying;Wang Yun(Department of cardiothoracic surgery,Qingdao Eighth People′s Hospital,Qingdao 266000,China;Department of cardiothoracic surgery,Qingdao Cardiovascular Hospital,Qingdao 266034,China)
出处
《中华肺部疾病杂志(电子版)》
2025年第3期467-471,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
关键词
肺磨玻璃结节
肺楔形切除术
单孔胸腔镜
三维重建技术
Pulmonary ground glass nodules
Wedge resection of the lung
Single hole thoracoscopy
3D reconstruction technology
作者简介
通信作者:王云,Email:wy-bbd@163.com。
