摘要
目的探讨全胸腔镜肺叶切除术治疗老年人非小细胞肺癌的临床疗效。方法选取120例老年非小细胞肺癌患者为研究对象，采用随机数字表法分为研究组60例和对照组60例，对照组采用传统开胸肺叶切除术治疗，研究组采用全胸腔镜肺叶切除术治疗，比较两组手术相关指标、术后疼痛情况、心肺功能、术后并发症及临床疗效。结果研究组术中出血量少于对照组[（138．44±41.53）mL比（327．83±54．61）mL]、术后引流量少于对照组[（1290．28±129．37）mL比（1643．19±231．27）mL]、手术时间短于对照组[（145．72±19．65）min比（243．26±50．38）min]、住院时间短于对照组[（7．43±1．59）d比（10．35±2．34）d]，差异均有统计学意义（t=21．383、10．316、13．972、7．995，均P〈0．05）。研究组术后1d[（7．57±1．63）分比（8．76±2．06）分]、3d[（5．46±0．82）分比（6．68±1．53）分]、7d[（2．51±0．41）分比（4．94±1．37）分]疼痛较对照组轻，差异均有统计学意义（t=3．509、5．444、13．162，均P〈0．05）。两组治疗前心肺功能差异均无统计学意义（t=0．207、0．287、1．112、0．137，均P〉0．05）；治疗后研究组心率（HR）[（83．27±12．85）次／min比（95．38±15．6）次／min]、一氧化碳弥散量（DLCO）[（67．49±6．84）％比（71．43±5．91）％]较对照组低，第1秒呼气容积（FEV1）[（1．67±0．25）L比（1．42±0．10）L]、最大通气量（MVV）[（74．34±0．56）％比（63．25±0．51）％]较对照组高，差异均有统计学意义（t=4．636、3．376、7．192、113．413，均P〈0．05）。研究组术后并发症发生率较对照组低（1．67％比11．67％）（χ^2=4．821，P〈0．05）。两组中位无瘤生存期（19．24个月比19．49个月）差异无统计学意义（u=0．571，P〉0．05）。两组无瘤生存率差异无统计学意义（P〉0．05）。结论全胸腔镜肺叶切除术对老年非小细胞肺癌患者心肺功能影响较小，创伤较轻，近期疗效优于传统开胸肺叶切除术，但远期疗效相似。
Objective To investigate the clinical effect of thoracoscopic lobectomy in the treatment of elderly patients with non - small cell lung cancer. Methods 120 elderly patients with non - small cell lung cancer were selected as study objects, and they were randomly divided into study group（60 cases） and control group （60 cases ） according to the digital table. The control group was treated with traditional thoracic lobectomy. The study group was treated with thoracoscopic lobectomy. The surgical related indicators, postoperative pain, cardiopulmonary function, postoperative complications and clinical efficacy were compared between the two groups. Results The blood loss of the study group was （138.44 ± 41.53）mL,which was less than （327.83 ± 54.61 ）mL of the control group, and the postoperative drainage was （ 1 290.28 ± 129.37） mL in the study group, which was less than （ 1 643.19 ± 231.27 ） mL in the control group. The operation time and hospitalization time of the study group were （ 145.72 ± 19.65 ） rain, （7.43 ± 1.59） d, respectively, which were shorter than （243.26 ± 50.38 ） min, （ 10.35 ± 2.34） d of the control group （ t = 21. 383,10.316,13. 972,7. 995, all P 〈 0.05 ）. 1,3,7 days after surgery, the VAS scores of the study group were significantly lower than those of the control group [ （7.57 ± 1.63 ） vs. （ 8.76 ± 2.06）, （ 5.46 ± 0.82 ） vs. （ 6.68 ± 1.53）, （2.51 ±0.41 ） vs. （4.94 ± 1.37） ,t = 3. 509,5. 444,13. 162,all P 〈0.05]. There was no statistically significant difference in cardiopulmonary function between the two groups before treatment （t = 0. 207,0. 287,1. 112, 0. 137, all P 〉 0.05）. After treatment, the heart rate （HR） and the carbon monoxide diffusion （DLCO） of the study group were significantly lower than those of the control group[ （83.27 ± 12.85 ）times/min vs. （95.38 ± 15.6）times/ min,（67.49 ±6.84）% vs. （71.43 ±5.91）% ] ,the FEV1 and mean ventilation volume（MVV） of the study group were significantly higher than those of the control group [ （ 1.67 ± 0.25 ） L vs. （ 1.42 ± 0.10 ） L, （74.34 ± 0. 56 ） % vs. （63.25 ± 0.51 ） % ], and the differences were statistically significant （ t = 4. 636,3. 376,7.192,113.413, all P 〈 0.05）. The incidence rate of postoperative complications in the study group was lower than that in the control group （ 1. 67% vs. I 1.67%, χ^2 = 4.821 ,P 〈 0.05 ）. There was no statistically significant difference between the two groups in median survival time（ 19.24 months vs. 19.49 months, u = 0. 571, P 〉 0.05）. There was no statistically significant difference in the disease free survival rate between the two groups （P 〉 0.05）. Conclusion Thoracoscopic lobectomy has less effect on eardiopulmonary function in elderly patients with non - small cell lung cancer. The short - term curative effect is better than traditional thoracic lobectomy, but the long - term curative effect is similar.
作者
张长存
张会平
Zhang Changcun, Zhang Huiping.(Department of Thoracic Surgery, the People＇s Hospital of Xuecheng District, Zaozhuang, Shandong 277000, China （Zhang C C ） ; Department of Rehabilitation,the People＇s Hospital of Xuecheng District , Zaozhuang , Shandong 277000, China（, Zhang HP）)
出处
《中国基层医药》
CAS
2018年第8期1038-1042,I0002,共6页
Chinese Journal of Primary Medicine and Pharmacy
