胸腔镜手术治疗肺曲霉病的效果和术后应激反应情况
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摘要
目的探讨胸腔镜手术治疗肺曲霉病的效果和术后应激情况。方法回顾性分析2011年2月~2016年9月海南省人民医院胸外科66例肺曲霉病患者的临床资料。根据手术方式将患者分为两组:传统开放组(36例)和胸腔镜组(30例)。比较两组临床指标、并发症发生率、疼痛评分情况、术前术后应激反应相关指标等情况。结果66例患者均顺利完成手术。与传统开放组相比,胸腔镜组手术时间更短、出血量更少,术后总引流量较少,术后7、30d疼痛评分更低,差异均有统计学意义(均P<0.05)。而两组患者术后住院时间,术后1d天疼痛评分以及术后并发症差异无统计学意义(P>0.05)。应激反应指标(皮质醇、前列腺素E2及P物质)比较,胸腔镜组患者术后第1天和第7天水平均较传统开放组降低,差异有统计学意义(P<0.05)。炎性反应指标(CRP、IL-6、TNF-α)比较,胸腔镜组术后第1天和第7天水平较传统开放组明显降低,差异均有统计学意义(P<0.05)。结论对肺曲霉病患者采用胸腔镜手术具有创伤小、恢复快、术后应激反应的影响较低等特点,值得临床推广应用。
Objective To discuss the possibility and safety of video-assisted thoracoscope surgery(VATS) for pul-monary aspergilloma and the postoperative stress reaction. Methods The clinical data of 66 patients with pulmonary aspergilloma in People′s Hospital of Hainan Province from February 2011 to September 2016 were retrospectively analyzed. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group(open group, n=36) and a video-assisted thoracoscope pneumonectomy group(VATS group, n=30).The clinical data, complications, NPS and stress reaction-related indicators of the two groups were observed after surgery. Results The operations of all patients were performed successfully. The VATS group was significantly lower than the open group in the operation time, bleeding, total postoperative drainage, the 7th day pain score and the 30 th day pain score(P<0.05). There were no statistical differences in the time of hospitalization, the 1 st day pain score and postoperation complication(P>0.05). In stress response indexes(cortisol, prostaglandin E2 and P substance), the postoperative levels of 1 st day and 7 th day in the VATS group were significantly lower than those in the open group(P<0.05). In inflammatory reaction indexes(C-reactive protein, interleukin 6 and tumor necrosis factor-α), the postoperative levels of 1 st day and 7 th day in the VATS group were significantly lower than those in the open group(P<0.05).Conclusion VATS for pulmonary aspergilloma, if applicable, may be reliable therapeutic effect, and less impact on the postoperative stress reaction. It is worthy of clinical application.
Objective To discuss the possibility and safety of video-assisted thoracoscope surgery(VATS) for pul-monary aspergilloma and the postoperative stress reaction. Methods The clinical data of 66 patients with pulmonary aspergilloma in People′s Hospital of Hainan Province from February 2011 to September 2016 were retrospectively analyzed. The patients were divided into two groups according to their operation method including a conventional thoracotomy surgery group(open group, n=36) and a video-assisted thoracoscope pneumonectomy group(VATS group, n=30).The clinical data, complications, NPS and stress reaction-related indicators of the two groups were observed after surgery. Results The operations of all patients were performed successfully. The VATS group was significantly lower than the open group in the operation time, bleeding, total postoperative drainage, the 7th day pain score and the 30 th day pain score(P<0.05). There were no statistical differences in the time of hospitalization, the 1 st day pain score and postoperation complication(P>0.05). In stress response indexes(cortisol, prostaglandin E2 and P substance), the postoperative levels of 1 st day and 7 th day in the VATS group were significantly lower than those in the open group(P<0.05). In inflammatory reaction indexes(C-reactive protein, interleukin 6 and tumor necrosis factor-α), the postoperative levels of 1 st day and 7 th day in the VATS group were significantly lower than those in the open group(P<0.05).Conclusion VATS for pulmonary aspergilloma, if applicable, may be reliable therapeutic effect, and less impact on the postoperative stress reaction. It is worthy of clinical application.
引文
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[14]Mohapatra B,Sivakumar P,Bhattacharya S,et al.Surgical treatment of pulmonary aspergillosis:A single center experience[J].Lung India,2016,33(1):9-13.
[15]Chen QK,Chen C,Chen XF,et al.Video-assisted thoracic surgery for pulmonary aspergilloma:a safe and effective procedure[J].Ann Thorac Surg,2014,97(1):218-223.
[16]Nagahiro I,Andou A,Aoe M,et al.Pulmonary function,postoperative pain,and serum cytokine level after lobectomy:a comparison of VATS and conventional procedure[J].Ann Thorac Surg,2001,72(2):362-365.
[17]Ichinose J,Kohno T,Fujimori S.Video-assisted thoracic surgery for pulmonary aspergilloma[J].Interact Cardiovasc Thorac Surg,2010,10(6):927-930.
[18]Walker WS,Leaver HA.Immunologic and stress responses following video-assisted thoracic surgery and open pulmonary lobectomy in early stage lung cancer[J].Thorac Surg Clin,2007,17(2):241-249.
[19]Jensen K,Ringsted C,Hansen HJ,et al.Simulationbased training for thoracoscopic lobectomy:a randomized controlled trial:virtual-reality versus black-box simulation[J].Surg Endosc,2014,28(6):1821-1829.
[20]傅毅立,李辉,胡滨,等.全胸腔镜肺切除术治疗肺曲霉菌球的病例对照研究[J].中国胸心血管外科临床杂志,2015,22(6):564-568.
[21]El HMM,Slaoui O,El OF,et al.Lung resection in pulmonary aspergilloma:experience of a Moroccan center[J].BMC Surg,2015,15:114.
[2]El HM,Traibi A,El OF,et al.Surgical treatment of aspergilloma grafted in hydatid cyst cavity[J].Rev Port Pneumol,2013,19(6):281-283.
[3]Ba PS,Ndiaye A,Diatta S,et al.Results of surgical treatment for pulmonary aspergilloma[J].Med Sante Trop,2015,25(1):92-96.
[4]严广斌.NRS疼痛数字评价量表numerical rating scale[J].中华关节外科杂志:电子版,2014,8(3):410.
[5]Kumar A,Asaf BB,Puri HV,et al.Video-assisted thoracoscopic surgery for pulmonary aspergilloma[J].Lung India,2017,34(4):318-323.
[6]Pagès PB,Grima R,Mordant P,et al.Does antifungal therapy influence postoperative morbidity or long-term survival after surgical resection for pulmonary aspergilloma?[J].Rev Pneumol Clin,2014,70(6):322-328.
[7]Stather DR,Tremblay A,Dumoulin E,et al.A Series of Transbronchial Removal of Intracavitary Pulmonary Aspergilloma[J].Ann Thorac Surg,2017,103(3):945-950.
[8]杜江,张林.58例肺曲霉菌病患者的临床特点及预后影响因素分析[J].山东医药,2015,55(10):45-47.
[9]Jewkes J,Kay PH,Paneth M,et al.Pulmonary aspergilloma:analysis of prognosis in relation to haemoptysis and survey of treatment[J].Thorax,1983,38(8):572-578.
[10]Afolayan O,Copeland H,Zaheer S,et al.Pulmonary Mucormycosis Treated With Lobectomy[J].Ann Thorac Surg,2017,103(6):e531-e533.
[11]Kasprzyk M,Pieczyński K,Mania K,et al.Surgical treatment for pulmonary aspergilloma-early and long-term results[J].Kardiochir Torakochirurgia Pol,2017,14(2):99-103.
[12]Rivera C,Arame A,Pricopi C,et al.Pneumonectomy for benign disease:indications and postoperative outcomes,a nationwide study[J].Eur J Cardiothorac Surg,2015,48(3):435-440,440.
[13]Li Y,Wang J.Comparison of clinical outcomes for patients with clinical N0 and pathologic N2 non-small cell lung cancer after thoracoscopic lobectomy and open lobectomy:a retrospective analysis of 76 patients[J].J Surg Oncol,2012,106(4):431-435.
[14]Mohapatra B,Sivakumar P,Bhattacharya S,et al.Surgical treatment of pulmonary aspergillosis:A single center experience[J].Lung India,2016,33(1):9-13.
[15]Chen QK,Chen C,Chen XF,et al.Video-assisted thoracic surgery for pulmonary aspergilloma:a safe and effective procedure[J].Ann Thorac Surg,2014,97(1):218-223.
[16]Nagahiro I,Andou A,Aoe M,et al.Pulmonary function,postoperative pain,and serum cytokine level after lobectomy:a comparison of VATS and conventional procedure[J].Ann Thorac Surg,2001,72(2):362-365.
[17]Ichinose J,Kohno T,Fujimori S.Video-assisted thoracic surgery for pulmonary aspergilloma[J].Interact Cardiovasc Thorac Surg,2010,10(6):927-930.
[18]Walker WS,Leaver HA.Immunologic and stress responses following video-assisted thoracic surgery and open pulmonary lobectomy in early stage lung cancer[J].Thorac Surg Clin,2007,17(2):241-249.
[19]Jensen K,Ringsted C,Hansen HJ,et al.Simulationbased training for thoracoscopic lobectomy:a randomized controlled trial:virtual-reality versus black-box simulation[J].Surg Endosc,2014,28(6):1821-1829.
[20]傅毅立,李辉,胡滨,等.全胸腔镜肺切除术治疗肺曲霉菌球的病例对照研究[J].中国胸心血管外科临床杂志,2015,22(6):564-568.
[21]El HMM,Slaoui O,El OF,et al.Lung resection in pulmonary aspergilloma:experience of a Moroccan center[J].BMC Surg,2015,15:114.