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中华胸部外科电子杂志 ›› 2016, Vol. 03 ›› Issue (01) : 35 -39. doi: 10.3877/cma.j.issn.2095-8773.2016.01.035

所属专题: 专题评论 文献

论著

胸腔镜手术对非小细胞肺癌患者快速康复的效果评价
范平明1, 吕鹏飞1,(), 郑武平1, 郑立平1, 高炳玉1   
  1. 1. 570100 海口,海南医学院附属医院乳腺胸部肿瘤外科
  • 收稿日期:2016-02-05 出版日期:2016-02-28
  • 通信作者: 吕鹏飞
  • 基金资助:
    海南省卫生厅科学研究课题基金资助(琼卫2010-44)

Outcomes of fast trackvideo-assisted thoracoscopic surgery fornon-smallcell lungcancer

Pingming Fan1, Pengfei Lyu1,(), Wuping Zheng1, Liping Zheng1, Bingyu Gao1   

  1. 1. Department of Breast Oncology, The Affiliated Hospital of Hainan Medical College, Haikou 570100, China
  • Received:2016-02-05 Published:2016-02-28
  • Corresponding author: Pengfei Lyu
  • About author:
    Corresponding author: Lyu Pengfei, Emaii:
引用本文:

范平明, 吕鹏飞, 郑武平, 郑立平, 高炳玉. 胸腔镜手术对非小细胞肺癌患者快速康复的效果评价[J/OL]. 中华胸部外科电子杂志, 2016, 03(01): 35-39.

Pingming Fan, Pengfei Lyu, Wuping Zheng, Liping Zheng, Bingyu Gao. Outcomes of fast trackvideo-assisted thoracoscopic surgery fornon-smallcell lungcancer[J/OL]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(01): 35-39.

目的

胸腔镜快速康复外科治疗非小细胞肺癌患者的临床应用及其效果评价,总结治疗经验。

方法

回顾性分析海南医学院附属医院2011年10月至2013年10月经手术治疗的240例非小细胞肺癌患者的临床资料,其中经全胸腔镜手术170例(胸腔镜组),传统开胸手术者70例(传统开胸组)。比较两组患者的手术时间、术中失血量、术后胸液总量、胸引管带管时间,以及术后住院时间和并发症发生率;观察麻醉前(T0)、切皮后1 h(T1)、术毕(T2)、术后24 h(T3)和术后48 h(T4)的免疫应激状态相关指标。

结果

两组均无围术期死亡病例,在出血量、手术时间、术后胸液总量、胸引管带管时间、术后住院时间方面胸腔镜组均优于传统开胸组,差异有统计学意义(t=-11.0,P=0.00;t=-3.2,P=0.00;t=-12.7,P=0.00;t=-9.4,P=0.00;t=-6.0,P=0.00);但两组患者的术后并发症发生率比较差异无统计学意义(χ2=1.48,P=0.22)。胸腔镜组在术后24 h(T3)和48 h(T4)的免疫因子指标高于传统开胸组,差异具有统计学意义(P<0.01)。在外周血中,胸腔镜组在术后24 h(T3)和48 h(T4)的去甲肾上腺素(NE)浓度低于传统开胸组,差异有统计学意义(t=-11.81,P=0.00;t=-20.06,P=0.00)。

结论

胸腔镜外科治疗非小细胞肺癌具有手术时间短、出血量少,以及术后住院时间短、引流量少、应激和免疫反应小等优势,值得广泛应用。

Objective

To investigate the outcomes of fast track video-assisted thoracoscopic surgery for non-smallcell lung cancer, and summarize the treatment experience.

Methods

The clinical data of 240 patients with non-smallcell lung cancer treated in the Affiliated Hospital of Hainan Medical College between October 2011and October 2013 were retrospectively analyzed. Among these 240 patients, 170 were treated by video-assisted thoracoscopic surgery (thoracoscopic surgery group), and the other 70 were managed with conventional thoracotomy(conventional thoracotomy group). The operation time, volume of blood loss during operation, volume of postoperative chest drainage, chest tube intubation time, postoperative hospital stay and incidence of complications were compared between two groups, and the related indicators of immune stress before anesthesia(T0), 1h after skin incision(T1), at the end of operation(T2), 24 h after operation(T3) and 48 h after operation(T4) were observed.

Results

There was no case ofperioperative death in two groups. The operation time, volume of blood loss during operation, volume of postoperative chest drainage, chest tube intubation time and postoperative hospital stay in thoracoscopic surgery group were significantly better than those in conventional thoracotomy group(t=-11.0, P=0.00; t=-3.2, P=0.00; t=-12.7, P=0.00; t=-9.4, P=0.00; t=-6.0, P=0.00). However, there was no significant difference in the incidence of postoperative complications between two groups (χ2=1.48, P=0.22). The related indicators of immune stress 24 h after operation (T3) and 48 h after operation (T4) in thoracoscopic surgery group were significantly higher than those in conventional thoracotomy group (P<0.01). The concentration of norepinephrine (NE) in the peripheral blood 24 h after operation (T3) and 48 h after operation (T4) in thoracoscopic surgery group was lower than that in conventional thoracotomy group (t=-11.81, P=0.00; t=-20.06, P=0.00).

Conclusions

Thoracoscopic surgery has the advantages of shorter operation time and hospitalization time, smaller volumes of blood loss during operation and postoperative drainage, less postoperative stress and immune response, and is worthy of application.

表1 胸腔镜组和传统开胸组基本资料比较
表2 胸腔镜组和开胸组术后一般临床指标比较(±s)
表3 胸腔镜组和传统开胸组患者手术前后CD3水平的变化(±s,g/L)
表4 胸腔镜组和传统开胸组患者手术前后CD4水平的变化(±s,g/L)
表5 胸腔镜组和传统开胸组患者手术前后CD8水平的变化(±s,g/L)
表6 胸腔镜组和传统开胸组患者手术前后HLA-DR水平的变化(±s,g/L)
表7 两组患者术后应激指标NE浓度的比较(mmol/L)
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