作者：梁建伟，曹兵，王晨，杜子豪

单位：

221000江苏省徐州市贾汪区人民医院胸外科

单位（英文）：

Department of Thoracic Surgery, the People's Hospital of Jiawang District of Xuzhou City, Xuzhou 221000, China

关键词：

癌，非小细胞肺；肺叶切除术；胸腔镜；Flex-3D胸腔镜；2D胸腔镜；治疗结果

关键词（英文）：

Carcinoma, non-small-cell lung; Pulmonary lobectomy; Thoracoscopes; Flex-3D thoracoscopy; 2D thoracoscopy; Treatment outcome

中图分类号：

R 730.26

DOI：

10.12114/j.issn.1008-5971.2024.00.041

基金项目：

摘要：

　目的　比较传统2D胸腔镜和Flex-3D胸腔镜在非小细胞肺癌（NSCLC）患者肺叶切除术中的应用效 果。方法　回顾性选取2021年11月—2023年7月在徐州市贾汪区人民医院行肺叶切除术的NSCLC患者83例为研究对 象。根据术中胸腔镜使用类型将患者分为Flex-3D组46例和2D组37例。2D组患者接受传统2D胸腔镜肺叶切除术， Flex-3D组患者接受Flex-3D胸腔镜肺叶切除术。术后15、30 d采用门诊复诊方式进行随访。比较两组围术期指标（手 术时间、术中出血量、24 h引流量、引流管留置时间和住院时间）、pTNM分期、淋巴结清扫数量，术后3、15、 30 d数字评定量表（NRS）评分，术前及术后15、30 d肺功能指标〔用力肺活量（FVC）、第1秒用力呼气容积占预 计值的百分比（FEV1%）〕，术后并发症（肺不张、肺部感染、肺栓塞、心律失常）发生率。结果　Flex-3D组手 术时间、引流管留置时间、住院时间短于2D组，术中出血量、24 h引流量少于2D组（P＜0.05）。两组pTNM分期、 淋巴结清扫数量比较，差异无统计学意义（P＞0.05）。手术方法和时间在NRS评分上存在交互作用（P＜0.05）； 手术方法、时间在NRS评分上主效应显著（P＜0.05）。Flex-3D组术后15 d NRS评分高于2D组，术后30 d NRS评分 低于2D组（P＜0.05）；两组术后15、30 d NRS评分分别低于本组术后3 d，术后30 d NRS评分分别低于本组术后15 d （P＜0.05）。手术方法和时间在FVC、FEV1%上不存在交互作用（P＞0.05）；手术方法、时间在FVC、FEV1%上主效 应显著（P＜0.05）。Flex-3D组术后15、30 d FVC、FEV1%高于2D组（P＜0.05）；两组术后15、30 d FVC、FEV1%分 别低于本组术前，术后30 d FVC、FEV1%分别高于本组术后15 d（P＜0.05）。两组术后肺不张、肺部感染、肺栓塞、 心律失常发生率比较，差异无统计学意义（P＞0.05）。结论　与传统2D胸腔镜肺叶切除术相比，Flex-3D胸腔镜肺叶 切除术能更有效地缩短NSCLC患者手术时间，减少出血量，进而缩短术后恢复时间，其还能更有效地减轻患者术后 30 d疼痛，促进术后肺功能的恢复，且二者的安全性相当。

英文摘要：

Objective To compare the application effect of traditional 2D thoracoscope and Flex-3D thoracoscope in pulmonary lobectomy of patients with non-small cell lung cancer (NSCLC) . Methods A total of 83 patients with NSCLC who underwent pulmonary lobectomy in the People's Hospital of Jiawang District of Xuzhou City from November 2021 to July 2023 were retrospectively selected as the research subjects, and divided into Flex-3D group (46 cases) and 2D group (37 cases) according to the type of thoracoscopy used during surgery. Patients in the 2D group underwent traditional 2D thoracoscopic lobectomy, while patients in the Flex-3D group were given Flex-3D thoracoscopic lobectomy. Patients were followed up at 15 and 30 days after surgery by outpatient return visit. The perioperative indicators (surgical time, intraoperative blood loss volume, 24 h drainage volume, drainage tube indwelling time and hospital stay) , pTNM staging, number of lymph node dissection, Numerical Rating Scale (NRS) score at 3, 15 and 30 days after surgery, pulmonary function indicators [forced vital capacity (FVC) , percentage of forced expiratory volume in one second to the expected value (FEV1) ] before surgery and at 15 and 30 days after surgery and incidence rates of postoperative complications (atelectasis, pulmonary infection, pulmonary embolism, arrhythmia) were compared between the two groups. Results The surgical time, drainage tube retention time and hospital stay in Flex-3D group were shorter than those in 2D group, and the intraoperative blood loss volume and 24 h drainage volume were less than those in 2D group (P < 0.05) . There were no statistically significant differences in the pTNM staging and number of lymph node dissection between the two groups (P > 0.05) . There was an interaction between surgical method and time on NRS score (P < 0.05) . The main effects of surgical method and time on NRS score were significant (P < 0.05) . The NRS score of the Flex-3D group was higher than that of the 2D group at 15 days after surgery, and lower than that of the 2D group at 30 days after surgery (P < 0.05) . The NRS score in both groups at 15 and 30 days after surgery was lower than that at 3 days after surgery, and the NRS score at 30 days after surgery was lower than that at 15 days after surgery, respectively (P < 0.05) . There was no interaction between operation method and time on FVC and FEV1% (P > 0.05) . The main effect of operation method and time on FVC and FEV1% was significant (P < 0.05) . FVC and FEV1% in Flex-3D group were higher than those in 2D group at 15 and 30 days after surgery (P < 0.05) . FVC and FEV1% at 15 and 30 days after surgery in both groups were lower than those before surgery, and FVC and FEV1% at 30 days after surgery were higher than those at 15 days after surgery, respectively (P < 0.05) . There were no statistical differences in the incidence rates of postoperative atelectasis, pulmonary infection, pulmonary embolism and arrhythmia between the two groups (P > 0.05) . Conclusion Compared with traditional 2D thoracoscopic lobectomy, Flex-3D thoracoscopic lobectomy can more effectively shorten the surgical time, reduce the blood loss volume, and shorten the postoperative recovery time of NSCLC patients. It can also more effectively relieve the pain at 30 days after surgery of patients and promote the recovery of postoperative pulmonary function, and the safety of the two methods is equivalent.

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