作者：陈国标，周建平，杜巍，叶志彬，卢星照，胡伟成，刘鑫

单位：

1.523000广东省东莞市人民医院心胸外科 2.511300广东省广州市增城区人民医院心胸外科 3.519100广东省珠海市，遵义医学院第五附属（珠海）医院心胸外科 通信作者：周建平，E-mail：987800679@qq.com

Units：

1.Cardiothoracic Surgery Department, the People's Hospital of Dongguan City, Dongguan 523000, China 2.Cardiothoracic Surgery Department, Zengcheng District People's Hospital, Guangzhou 511300, China 3.Cardiothoracic Surgery Department, the Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, Zhuhai 519100, China Corresponding author: ZHOU Jianping, E-mail: 987800679@qq.com

关键词：

肺肿瘤; 早期治疗; 胸腔镜手术; 肺楔形切除术; 肺段切除术; 肺叶切除术; 疗效比较研究;

Keywords：

Lung neoplasms; Early therapy; Thoracoscopic surgeries; Wedge resection of the lung; Segmentalresection; Lobectomy; Comparative effectiveness research

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.108

Funds：

广东省自然科学基金资助项目（2015A030313046）；2019年东莞市社会科技发展（一般）项目（201950715001912）

摘要：

目的 比较胸腔镜肺楔形切除术、胸腔镜下肺段切除术和胸腔镜肺叶切除术治疗早期肺癌的疗效。方法 回顾性选取2017-06-01至2019-09-30东莞市人民医院心胸外科收治的早期肺癌患者112例为研究对象。根据手术方法将患者分为A组(胸腔镜肺楔形切除术,38例)、B组(胸腔镜下肺段切除术,36例)、C组(胸腔镜肺叶切除术,38例)。比较三组患者手术情况(包括手术时间、术中出血量、引流量、引流时间、淋巴结清扫个数)及住院天数,术前、术后24 h和术后72 h视觉模拟评分法(VAS)评分,术前、术后3 d、术后1个月和术后3个月肺功能指标〔包括用力肺活量(FVC)、第1秒用力呼气容积(FEV1)〕和炎症指标(包括白细胞计数和中性粒细胞计数),预后情况和并发症发生情况。结果 B组、C组患者引流量大于A组,引流时间、住院时间长于A组(P<0.05);C组患者引流量大于B组,引流时间、住院时间长于B组(P<0.05)。手术方法与时间在VAS评分上存在交互作用(P<0.05);手术方法、时间在VAS评分上主效应显著(P<0.05)。B组、C组患者术后24、72 h VAS评分高于A组(P<0.05);C组患者术后24、72 h VAS评分高于B组(P<0.05)。A组、B组、C组患者术后24、72 h VAS评分分别高于本组术前,术后72 h VAS评分分别低于本组术后24 h(P<0.05)。手术方法与时间在FVC、FEV1、白细胞计数、中性粒细胞计数上存在交互作用(P<0.05);手术方法、时间在FVC、FEV1、白细胞计数、中性粒细胞计数上主效应显著(P<0.05)。B组、C组患者术后1个月、术后3个月FVC、FEV1低于A组,白细胞计数、中性粒细胞计数高于A组(P<0.05);C组患者术后1个月、术后3个月FVC、FEV1低于B组,白细胞计数、中性粒细胞计数高于B组(P<0.05)。A组、B组、C组患者术后3 d FVC、FEV1分别低于本组术前,白细胞计数、中性粒细胞计数分别高于本组术前(P<0.05);A组、B组、C组患者术后1个月、术后3个月FVC、FEV1分别高于本组术前、术后3 d,白细胞计数、中性粒细胞计数分别低于本组术前、术后3 d(P<0.05);A组、B组、C组患者术后3个月FVC、FEV1分别高于本组术后1个月,白细胞计数、中性粒细胞计数分别低于本组术后1个月(P<0.05)。三组术后1年均无患者死亡,亦无患者出现复发转移。三组患者并发症发生率比较,差异无统计学意义(P>0.05)。结论 三种胸腔镜手术方法中,胸腔镜肺楔形切除术治疗早期肺癌的疗效最好,其次为胸腔镜下肺段切除术,最后为胸腔镜肺叶切除术,其均可缓解患者的疼痛程度,促进肺功能的恢复,减轻炎症反应,且安全性好。

Abstract：

【Abstract】　Objective To investigate the curative effect of thoracoscopic lung wedge resection, thoracoscopicsegmentectomy and thoracoscopic lobectomy in the treatment of early stage lung cancer. Methods A total of 112 patients withearly stage lung cancer who were admitted to the Cardiothoracic Surgery Department of the People's Hospital of Dongguan Cityfrom 2017-06-01 to 2019-09-30 were retrospectively selected as the research objects. According to the surgical method, thepatients were divided into group A (thoracoscopic wedge resection, 38 cases) , group B (thoracoscopic segmentectomy, 36 cases) ,and group C (thoracoscopic lobectomy, 38 cases) . The surgical condition (including operation time, intraoperative blood loss,drainage volume, drainage time, number of lymph node dissections) and hospitalization time, Visual Analogue Scoring (VAS) scorebefore operation, 24 hours after operation and 72 hours after operation, pulmonary function indexes [including forced vital capacity(FVC) , forced expiratory volume in one second (FEV1) ] and inflammatory indexes (including white blood cell countand neutrophilcount) before operation, 1 day after operation, 5 days after operation, and 3 months after operation, prognosis and complicationsamong the three groups of patients were compared.ResultsThe drainage volume of patients in group B and group C was greaterthan that of group A, and the drainage time and hospitalization time were longer than those in group A (P <0.05) . The drainagevolume of patients in group C was greater than that of group B, and the drainage time and hospitalization time were longer thanthose in group B (P <0.05) . There was an interaction between surgical method and time on VAS score (P <0.05) ; the main effectof surgical method and time on VAS score was significant (P <0.05) . The VAS scores of group B and group C were higher thanthose of group A at 24 and 72 hours after operation (P <0.05) ; the VAS scores of patients in group C at 24 and 72 hours afteroperation were higher than those of group B (P <0.05) . The VAS scores of patients in group A, group B, and group C at 24 and 72hours after operation were higher than those before operation, and the VAS scores at 72 hours after operation were lower than thoseat 24 hours after operation, respectively (P <0.05) . There was an interaction between surgical method and time on FVC, FEV1,white blood cell count, and neutrophil count (P <0.05) ; the main effect of surgical method and time on FVC, FEV1, white bloodcell count, and neutrophil count was significant (P <0.05) . The FVC and FEV1 of group B and group C were lower than those ofgroup A at 1 month and 3 months after operation, and the white blood cell count and neutrophil count were higher than those ofgroup A (P <0.05) ; the FVC and FEV1 in group C were lower than those in group B at 1 month and 3 months after operation, andthe white blood cell count and neutrophil count in group C were higher than those in group B (P <0.05) . At 3 days after operation,the FVC and FEV1 of group A, group B, and group C were lower than those before operation, and the white blood cell count andneutrophil count were higher than those before operation, respectively (P <0.05) ; at 1 month and 3 months after operation, theFVC and FEV1 of patients in group A, group B, and group C were higher than those before operation and 3 days after operation,and the white blood cell count and neutrophil count were lower than those before operation and 3 days after operation, respectively(P<0.05) ; at 3 months after operation, the FVC and FEV1 of group A, group B, and group C were higher than those at 1 monthafter operation, and the white blood cell count and neutrophil count were lower than those at 1 month after operation, respectively(P<0.05) . In the three groups, no patient died 1 year after operation, and no patient had recurrence or metastasis. There wasno significant difference in the incidence of complications among the three groups (P > 0.05) .Conclusion Among the threethoracoscopic surgical methods, thoracoscopic wedge resection has the best curative effect in the treatment of early stage lungcancer, followed by thoracoscopic segmentectomy, and finally thoracoscopic lobectomy, all of which can relieve the pain degree ofpatients, promote the recovery of lung function, reduce the inflammatory response, and have good safety.

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