胸腔镜肺叶切除与亚肺叶切除对肺功能影响的比较

发布时间：2018-12-08 18:38

【摘要】：目的:通过对行胸腔镜肺叶切除和亚肺叶切除术患者术后随访及数据分析,总结归纳行两种术式患者的临床数据特点,探讨胸腔镜亚肺叶切除术在治疗肺部疾病的可行性、安全性及手术适应证,为亚肺叶切除的下一步发展提供必要的理论依据和科学的实验数据。方法:筛选2015年6月至2016年6月我院胸外科诊治的行胸腔镜亚肺叶切除手术及胸腔镜肺叶切除手术120例,根据手术方式的不同将所选患者分为肺叶切除术组68例和亚肺叶切除术组52例。所选120例患者均行常规术前检查,入院第二天抽取空腹静脉血查血、生化全项、血凝全项、动脉血气以及肿瘤标志物,查尿、大便常规、查支气管镜、肺部CT、全身ECT及全身PET-CT、测定肺功能,明确诊断疾病,完善术前准备,制定手术计划,择期手术。两组患者在性别、吸烟史、术前肺功能指标FEV1、FEV1%、FVC、MVV%及血气分析指标Pa O2、Pa CO2无统计学差异,有可比性。比较两组患者围手术期、术后10天、3个月的肺功能变化,观察指标包括FEV1%、FVC%、MVV%、Pa O2、Pa CO2。结果:比较两组年龄、性别、吸烟史、既往病史、手术时间、术中出血量、术后住院时间、术后闭式引流时间以及手术相关并发症发生情况,结果显示两组患者在年龄、术后闭式引流时间48h、术后住院时间、术后并发症(肺不张、左心衰、血胸)等方面存在显著差异,有统计学意义(p0.05)。而在性别、吸烟史、既往病史、手术时间、术中出血量等方面,胸腔镜肺叶切除术组与亚肺叶切除术组两组患者间无显著差异,无统计学意义。测定两组患者术前及术后10天及3个月肺功能并比较,结果显示两组患者术前肺功能指标FEV1%、FVC%、MVV%无统计学差异(p0.05);两组患者肺功能FEV1%、FVC%、MVV%术后均较术前减小,差异明显有统计学意义(p0.05);且术后胸腔镜亚肺叶切除术组患者FEV1%明显高于胸腔镜肺叶切除术患者,差异显著有统计学意义(p0.05),但两组患者术后在FVC%、MVV%上无显著差异无统计学意义(p0.05)。观察两组患者术前及术后1、3、7天Pa O2、Pa CO2值并比较,结果显示两组患者术前动脉血气分析无显著差异无统计学意义(p0.05);两组患者术后第1天、第3天Pa O2值差异显著有统计学意义(p0.05),而Pa CO2无统计学意义(p0.05);两组患者术后第7天Pa O2、Pa CO2值差异均不显著,无统计学意义(p0.05)。结论:与胸腔镜肺叶切除术比较,亚肺叶切除术在肺癌治疗上有效性、安全性均较高,亚肺叶切除术可以取得和肺叶切除术相当的疗效而可以保留更多的正常肺组织,减少术后并发症,术后生活质量明显改善。
[Abstract]:Objective: to summarize the clinical data of patients undergoing thoracoscopic lobectomy and sublobectomy, and to explore the feasibility of thoracoscopic sublobectomy in the treatment of pulmonary diseases. The safety and indications of operation provide the necessary theoretical basis and scientific experimental data for the further development of sublobectomy. Methods: from June 2015 to June 2016, 120 cases of thoracoscopic sublobectomy and thoracoscopic lobectomy were selected. The patients were divided into lobectomy group (n = 68) and sublobectomy group (n = 52). All 120 patients underwent routine preoperative examination. Fasting venous blood samples were collected on the second day of admission for examination of blood, biochemistry, blood coagulation, arterial blood gas and tumor markers, routine examination of urine, stool, bronchoscopy and pulmonary CT,. Systemic ECT and systemic PET-CT, were used to determine lung function, to diagnose disease, to perfect preoperative preparation, to make operation plan, and to select operation. There were no significant differences in sex, smoking history, preoperative pulmonary function index (FEV1,FEV1%,FVC,MVV%) and blood gas analysis index (Pa O _ 2 Pa CO2) between the two groups. The changes of pulmonary function during perioperative period, 10 days and 3 months after operation were compared between the two groups. The observed indexes included FEV1%,FVC%,MVV%,Pa O2Pa CO2.. Results: age, sex, smoking history, medical history, operation time, intraoperative bleeding volume, postoperative hospitalization time, postoperative closed drainage time and operative complications were compared between the two groups. There were significant differences in postoperative closed drainage time, postoperative hospitalization time, postoperative complications (atelectasis, left heart failure, and hemothorax) (p0.05). However, there was no significant difference in sex, smoking history, previous medical history, operative time and intraoperative bleeding volume between the two groups in thoracoscopic lobectomy group and sublobectomy group. Pulmonary function was measured and compared between the two groups before operation and 10 days and 3 months after operation. The results showed that there was no significant difference in preoperative FEV1%,FVC%,MVV% between the two groups (p0.05). The pulmonary function of the two groups decreased after FEV1%,FVC%,MVV% compared with the preoperative, the difference was statistically significant (p0. 05). The FEV1% of patients after thoracoscopic sublobectomy was significantly higher than that of patients with thoracoscopic lobectomy (p0.05), but the difference between the two groups was significant (p0.05). There was no significant difference on MVV% (p0. 05). The CO2 values of Pa O _ 2 Pa were observed and compared between the two groups before operation and 1: 3 days after operation. The results showed that there was no significant difference between the two groups in preoperative arterial blood gas analysis (p0.05). There were significant differences in Pa O 2 values between the two groups on the first day and the third day after operation (p0.05), but Pa CO2 had no statistical significance (p0.05). There was no significant difference in Pa O _ 2 Pa CO2 between the two groups on the 7th day after operation (p0.05). Conclusion: compared with thoracoscopic lobectomy, sublobectomy is effective and safe in the treatment of lung cancer. Sublobectomy can achieve the same curative effect as lobectomy and retain more normal lung tissue. The postoperative complications were reduced and the quality of life was improved significantly.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.3

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