单孔胸腔镜与两孔胸腔镜手术治疗非小细胞肺癌的手术相关指标和实验室指标比较

目的比较单孔胸腔镜与两孔胸腔镜手术治疗非小细胞肺癌的临床效果,并比较两种手术的手术相关指标和实验室指标。方法采用回顾性研究方法选取2017年1月至2019年1月广西医科大学第一临床医学院心胸外科收治的105例非小细胞肺癌(NSCLC)患者作为研究对象,根据手术方式不同将患者分为两组:观察组(n=48)和对照组(n=57)。观察组患者行单孔胸腔镜手术,对照组患者行两孔胸腔镜手术。观察并比较两组患者的手术相关指标(手术成功率、术中中转开胸率、术中淋巴结清扫数量、手术时间、术中出血量、术后拔管时间、下床活动时间、术后3 d VAS评分)、实验室指标血清癌胚抗原(CEA)、糖类抗原125(CA125)、鳞状细胞癌抗原(SCC-Ag)、白细胞介素-1(IL-1)、降钙素原(PCT)、C反应蛋白(CRP)、P物质(SP)、前列腺素E2、去甲肾上腺素(NE)]和术中并发症发生情况。结果对照组与观察组患者的手术成功率(96.49%vs.97.92%)、术中中转开胸率(3.51%vs.2.08%)、术中淋巴结清扫数量(16.02±6.54)个vs.(17.52±5.24)个]比较,差异均无统计学意义(P>0.05);观察组患者的手术时间(194.62±40.58)min vs.(157.62±33.62)min]、术中出血量(114.65±25.94)ml vs.(89.57±22.41)ml]、术后拔管时间(5.38±1.93)d vs.(3.47±1.07)d]、下床活动时间(6.22±1.57)d vs.(4.99±1.72)d]、术后3 d VAS评分(4.86±1.37)分vs.(3.04±0.57)分]显著优于对照组,差异具有统计学意义(P<0.05);两组患者的血清癌胚抗原(CEA)(6.24±0.75)ng/ml vs.(6.16±0.71)ng/ml]、糖类抗原125(CA125)(31.25±4.21)U/ml vs.(30.27±4.92)U/ml]、鳞状细胞癌抗原(SCC-Ag)(1.25±0.42)ng/ml vs.(1.24±0.39)ng/ml]比较,差异均无统计学意义(P>0.05);观察组患者的血清白细胞介素-1(IL-1)(24.58±5.23)ng/L vs.(10.37±1.24)ng/L]、降钙素原(PCT)(0.88±0.24)ng/ml vs.(0.41±0.12)ng/ml]、C反应蛋白(CRP)(19.65±2.73)mg/L vs.(11.25±2.04)mg/L]显著低于对照组,差异均具有统计学意义(P<0.05);观察组患者的P物质(SP)(7.63±1.29)μg/ml vs.(18.24±3.24)μg/ml]、前列腺素E2(PGE2)(146.7±24.93)pg/ml vs.(259.37±34.62)pg/ml]、去甲肾上腺素(NE)(154.27±32.55)ng/L vs.(268.55±40.93)ng/L]显著低于对照组,差异均具有统计学意义(P<0.05);两组患者的肺不张、肺部感染、持续液气胸、房颤发生率比较,差异均无统计学意义(P>0.05)。结论单孔胸腔镜与两孔胸腔镜手术治疗非小细胞肺癌的效果相似但前者对患者的创伤程度更小,疼痛应激和炎症反应更轻,更有利于患者的术后康复。

Comparison of surgery-related and laboratory data for single-port thoracoscopy and two-port thoracoscopy for non-small cell lung cancer

Objective To compare the clinical effect and surgery-related and laboratory data of single-port thoracoscope and two-port thoracoscope in the treatment of non-small cell lung cancer.Methods 105 patients with non-small cell lung cancer(NSCLC) admitted to the Department of Cardiothoracic Surgery of the First Clinical Medical College of Guangxi Medical University from January 2017 to January 2019 were selected in this retrospective study.The patients were divided into two groups:observation group(n=48) and control group(n=57).Patients in the observation group underwent single-port thoracoscopy,and patients in the control group underwent two-port thoracoscopy.The surgeryrelated data(operative successful rate,conversion to thoracotomy rate,the number of lymph node dissection during the operation,operation time,intraoperative bleeding volume,postoperative extubation time,time to get out of bed,VAS scores 3 days after operation),laboratory data serum carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),squamous cell carcinoma antigen(SCC-Ag),interleukin-1(IL-1),procalcitonin(PCT),C-reactive protein(CRP),substance P(SP),prostaglandin E2(PGE2),norepinephrine(NE)] and intraoperative complications were observed and compared.Results There were no significant differences between the control group and the observation group in operative successful rate(96.49% vs.97.92%),conversion to thoracotomy rate(3.51% vs.2.08%),and the number of lymph node dissection during the operation (16.02±6.54) vs.(17.52±5.24)](P>0.05);compared with the control group,the operation time (194.62±40.58) min vs.(157.62±33.62) min],the intraoperative bleeding volume (114.65±25.94) ml vs.(89.57±22.41) ml],postoperative extubation time (5.38±1.93) d vs.(3.47±1.07) d],time to get out of bed (6.22±1.57) d vs(4.99±1.72) d],VAS scores 3 days after operation (4.86±1.37) points vs.(3.04±0.57) points] in the observation group were significantly better,and the differences were statistically significant(P <0.05),there were no significant differences in CEA (6.24±0.75) ng/ml vs.(6.16±0.71) ng/ml],CA125(31.25±4.21) U/ml vs.(30.27±4.92) U/ml],SCC-Ag (1.25±0.42) ng/ml vs.(1.24±0.39) ng/ml] between the two groups(P> 0.05);compared with the control group,IL-1 (24.58±5.23) ng/L vs.(10.37±1.24) ng/L],PCT (0.88±0.24) ng/ml vs.(0.41±0.12) ng/ml],CRP (19.65±2.73) mg/L vs.(11.25±2.04) mg/L] in the observation group were significantly lower,and the differences werestatistically significant(P <0.05);SP (7.63±1.29)μg/ml vs.(18.24±3.24) μg/ml],PGE2 (146.7±24.93) pg/ml vs·(259.37±34.62) pg/ml],NE (154.27±32.55) ng/L vs.(268.55±40.93) ng/L] in the observation group were significantly lower,and the differences were statistically significant(P <0.05).There were no significant differences between the two groups in the incidence of atelectasis,pulmonary infection,persistent pneumothorax,and atrial fibrillation(P> 0.05).Conclusion The effect of single-port thoracoscopy and two-port thoracoscopy in the treatment of non-small cell lung cancer are almost the same,but the former is less invasive,with lighter the pain and inflammatory response,and is more conducive to postoperative recovery.