电视胸腔镜在原发性非小细胞肺癌手术治疗中的应用

发布时间：2018-06-28 01:50

本文选题：电视胸腔镜 + 电视胸腔镜肺叶切除术　；参考：《新乡医学院》2015年硕士论文

【摘要】：目的比较探讨电视胸腔镜手术(video assist thoracoscopic surgery, VATS)和传统开胸肺癌根治术治疗原发性非小细胞癌(non-small cell lung cancer, NSCLC)的临床应用价值。方法选取2013年1月～2014年6月入我院胸外科住院手术治疗的早期原发性非小细胞癌患者80例,术前开展胸部CT、CT引导下穿刺或支气管镜检等检查,均经临床初步诊断为早期周围型肺癌,将其分为电视胸腔镜手术组(观察组,n=42例)和传统开胸肺癌根治术组(对照组,n=38例),两组患者均接受肺叶切除术及系统性淋巴结清扫术治疗,比较两组患者围手术期指标、相关实验室指标与生活质量改变情况。结果两组患者的年龄、性别、合并基础疾病、肿瘤部位及其直径、病理类型及术后病理分期等资料比较差异均无统计学意义(P0.05)。两组患者的手术时间、术后白细胞、血清前白蛋白和住院费用比较差异无统计学意义(P0.05)。观察组患者的术中出血量少于对照组,术后引流量少于对照组,术后首次下床时间和术后住院时间均短于对照组,组间比较差异均有统计学意义(P0.05)。两组患者在淋巴结清扫数目、转移淋巴结数目、术后复发与转移方面比较差异无统计学意义(P0.05)术前两组患者超敏C-反应蛋白水平(high-sensitivity C-reactiveprotein, hs-CRP)比较差异无统计学意义(P0.05),术后两组患者超敏C反应蛋白(hs-CRP)均较术前升高(P0.05),其中观察组hs-CRP水平明显低于对照组,组间比较差异有统计学意义(p0.05)。两组患者术前肺活量(vital capacity, VC)、第一秒用力呼气量(forced expiratory volume in 1 second,FEV1)、最大通气量(maximal voluntary ventilation, MVV)三项指标比较均无明显差异(P0.05),术后1个月和3个月两组患者上述指标比较差异均有统计学意义(P0.05)。两组患者术前生活质量比较差异无统计学意义(P0.05),术后均较术前明显提高,两组术后比较差异均有统计学意义(P0.05)。观察组患者的生理状况和功能状况评分均明显高于对照组,比较差异均有统计学意义(P0.05)。结论电视胸腔镜肺叶切除术与传统开胸手术在淋巴结清扫、术后复发与转移等方面的近期疗效相当。但与后者相比,电视胸腔镜肺叶切除术具有微创、术后肺功能损害小、恢复快、术后住院时间短、患者早中期生活质量高等优点,可作为一种治疗早期非小细胞肺癌的常规手段,具有临床推广应用价值。
[Abstract]:Objective to evaluate the clinical value of video-assisted thoracoscopic surgery (video assist thoracoscopic surgery, vats) and conventional radical thoracotomy for primary non-small cell carcinoma (non-small cell lung cancer, NSCLC). Methods from January 2013 to June 2014, 80 patients with early primary non-small cell carcinoma (NSCC) admitted to our hospital from January 2013 to June 2014 were examined by CT guided puncture or bronchoscopy. All patients were clinically diagnosed as early peripheral lung cancer. The patients were divided into two groups: video-assisted thoracoscopic surgery group (n = 42) and conventional thoracotomy group (n = 38). The patients in both groups were treated with lobectomy and systemic lymph node dissection. The perioperative indexes were compared between the two groups. Changes in laboratory indicators and quality of life. Results there was no significant difference in age, sex, underlying diseases, tumor location and diameter, pathological types and postoperative pathological stages between the two groups (P0.05). There was no significant difference in operation time, white blood cell, serum prealbumin and hospitalization cost between the two groups (P0.05). The amount of intraoperative bleeding in the observation group was less than that in the control group, the postoperative drainage volume was less than that in the control group, the first time of getting out of bed and the time of hospitalization after operation were shorter than those in the control group, and the differences between the two groups were statistically significant (P0.05). The number of lymph node dissection and metastatic lymph nodes in both groups, There was no significant difference in postoperative recurrence and metastasis (P0.05). There was no significant difference in high-sensitivity C-reactive protein (hs-CRP) between the two groups before operation (P0.05). The level of hs-CRP in the observation group was significantly lower than that in the control group. The difference between the two groups was statistically significant (p 0.05). There were no significant differences among the three indexes of vital capacity (vital capacity, VC), forced expiratory volume (forced expiratory volume in 1 second FEV1) and maximal ventilation volume (maximal voluntary ventilation, MV) in the two groups before operation (P0.05), but there were significant differences between the two groups at 1 month and 3 months after operation (P0.05). There was no significant difference in the quality of life between the two groups before operation (P0.05), and there was significant difference between the two groups after operation (P0.05). The scores of physiological and functional status in the observation group were significantly higher than those in the control group, and the differences were statistically significant (P0.05). Conclusion Video-assisted thoracoscopic lobectomy and traditional thoracotomy are effective in lymph node dissection, recurrence and metastasis. But compared with the latter, video-assisted thoracoscopic lobectomy has the advantages of minimally invasive, small postoperative lung function damage, rapid recovery, short postoperative hospital stay and high quality of life. It can be used as a routine therapy for early non-small cell lung cancer.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2

【参考文献】