全胸镜肺叶切除术在早期非小细胞肺癌治疗中的应用研究

目的 研究全胸镜肺叶切除术(VATS)与开胸肺叶切除术(PL)治疗早期非小细胞肺癌(NSCLC)的疗效、彻底性及安全性.方法 选取早期NSCLC患者106例,依照随机数字表法1:1分为VATS组与PL组,每组各53例.VATS组行VATS治疗,PL组行PL治疗.观察两组手术时间、淋巴结清扫数、术中出血量、输血量、术后引流时间、总引流量、下床活动时间等手术指标,术前及术后7 d TNF-α、CRP、IL-6、CD3+、CD4+、CD8+及CD4+/CD8+等水平,疼痛程度,术后并发症、复发及1~3年生存情况.结果 VATS组术中出血量、治疗期间总输血量、下床活动时间以及疼痛程度评分均低于PL组,差异均有统计学意义(P<0.05).VATS组术后7 d患者血清中的CRP、IL-6、TNF-α与术前的差值均低于PL组各指标手术前后的差值,差异有统计学意义(P<0.05).VATS组术后7 d患者血清中的CD3+、CD4+、CD8+及CD4+/CD8+与本组术前的差值均高于PL组手术前后各指标的差值,差异有统计学意义(P<0.05).VATS组术后并发症发病率(15.09%)低于PL组(35.85%)(P<0.05);VATS组术后1~3年生存率高于PL组(P<0.05).结论 VATS治疗NSCLC创伤小,对免疫系统影响小,疗效显著,治疗彻底安全,值得应用于临床.

Application of video-assisted thoracic surgery lobectomy in the treatment of early stage non-small cell lung cancer

Objective To evaluate the efficacy and safety of video-assisted thoracic surgery (VATS) lobectomy and pulmonary lobectomy (PL) in the treatment of early stage non-small cell lung cancer (NSCLC). Method 106 cases of early-stage NSCLC patients were included in the analysis, and were randomized as VATS group and PL group as per a random number table (1:1), with 53 cases in each. VATS or PL lobectomy was administered, respectively. All patients were observed for operative time, number of dissected lymph nodes, intraoperative blood loss, transfusion and postopera-tive drainage and the total volume of drainage, ambulation time, the level of TNF-α, CRP,IL-6, CD3+, CD4+, CD8+and CD4+/CD8+in 7 d before and after surgery, the degree of pain, postoperative complications, relapse and 1-to 3-year sur-vival. Result The intraoperative blood loss, total volume of blood transfusions during treatment, ambulation time and pain scores were lower in VATS group than PL group, with statistically significant difference observed (P<0.05). The dif-ferences of CRP,IL-6, TNF-α in 7 d after surgery vs 7d before surgery were minor in VATS group compared with PL group (P<0.05), while the VATS group had more obvious change in regard of CD3+, CD4+, CD8+and CD4+/CD8+levels in 7 d after surgery than PL group, with significant difference observed (P<0.05). The incidence of postoperative complica-tions in VATS Group (15.09%) was significantly lower than that of PL Group (35.85%) (P<0.05), and higher 1-to 3-year survival rate was observed in VATS group (P<0.05). Conclusion VATS is less invasive in treating NSCLC, imposing lit-tle impact on the immune system, with acceptable efficacy and safety, and is worthy of clinical application.