全胸腔镜与开胸肺叶切除术对NSCLC患者围术期的影响比较

目的通过对比Ⅰ期和除T3N0M0外的Ⅱ期非小细胞肺癌（NSCLC）患者行全胸腔镜（c-VTAS）或传统后外侧开胸（CPT）肺叶切除术的白细胞计数（WBC-C）、超敏反应C蛋白（hs-CRP）的含量及临床相关指标,比较两种术式对患者围术期的影响。方法连续选取拟行肺叶切除术的Ⅰ期及除T3N0M0外的Ⅱ期NSCLC患者67例,分为c-VTAS组34例,CPT组33例。检测两组患者术前、术后外周血中WBC-C和hs-CRP的水平,收集相关临床指标,并进行统计分析。结果术后两组患者WBC-C及hs-CRP水平较术前升高（P〈0.01）;术后c-VATS组WBC-C及hs-CRP水平明显低于CPT组（P〈0.01）。两组无死亡、严重并发症及二次手术病例;c-VATS组术中出血量、开始下床活动时间、疼痛评分低于CPT组（P〈0.01）;两组手术时间、清扫淋巴结组数和个数、引流量、引流时间、住院天数、并发症无统计学差异（P〉0.05）;术后两组肿瘤病理分期总体有升级趋势,出现了Ⅲ期病例。结论 c-VTAS肺叶切除对患者围术期影响小,具有安全、淋巴结清扫彻底及微创的优点。

Comparison of effects between pulmonary lobectomy by complete video-assisted thoracoscopic surgery and conventional posterolateral thoracotomy on patients with NSCLC in perioperative period

Objective To make comparison in the contents of white blood cell count(WBC-C)and hypersensitive C reaction protein(hs-CRP)and other clinical indexes between pulmonary lobectomy by complete video-assisted thoracoscopic surgery(c-VATS)and conventional posterolateral thoracotomy(CPT)in treatment of patients with stageⅠand stageⅡapart from T3N0M0 non-small cell lung cancer(NSCLC),and to compare the effects of these two therapies on patients in the perioperative period.Methods Sixty seven stageⅠand stageⅡapart from T3N0M0 NSCLC patients who planned to receive pulmonary lobectomy were successively chosen and divided into c-VATS group(34 cases)and CPT group(33 cases).WBC-C and hs-CRP levels in the peripheral blood of the two groups were detected before and after the operation.Clinical indexes were collected and statistically analyzed.Results The WBC-C and hs-CRP levels in both groups increased after the operation(P<0.01).After the operation,the WBC-C and hs-CRP levels in c-VATS group were significantly lower than those in CPT group(P<0.01).There were no death,severe complications and reoperation in the two groups.In c-VATS group,blood loss during operation,time of first out-of-bed activity and pain score were very significantly lower than those in CPT group(P<0.01).There was no significant difference in operative time,group count and numbers of dissected lymph node,drainage volume,length of drainage,hospital stay and complications between the two groups(P>0.05).After the operation,the pathological stage of tumor in the two groups had a tendency of upgrading,and cases stage Ⅲ tumor occurred.Conclusion Pulmonary lobectomy by c-VATS has smaller influence on patients in the perioperative period and has safe and good curative effects in minimal invasion and thorough lymph node dissection.