不同的手术方案切除恶性纵膈肿瘤对患者ACTH、CRP、TNF-α、COR含量及预后影响的对比分析
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摘要
目的分析不同手术方案对恶性纵膈肿瘤患者的促肾上腺皮质激素(ACTH)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)及血浆皮质醇(COR)等指标含量、术后并发症及预后情况的影响。方法随机选取138例恶性纵膈肿瘤患者,并随机分为对照组和观察组。对照组行传统开胸手术方式治疗;治疗组行胸腔镜下微创术进行肿瘤切除。对比2组患者治疗效果,记录患者手术时间、术中出血量、术后止痛时间、术后住院时间、视觉疼痛模拟评分法(VAS)评分及手术前后CRP、ACTH、COR、TNF-α含量等指标。结果观察组的有效率为89.85%(62/69),明显高于对照组的有效率73.91%(52/69)(P <0.05)。观察组患者的术中失血量、术后止痛时间、住院时间及疼痛评分明显少于对照组;但观察组患者的手术时间为(97.96±9.84) min,略微高于对照组的(89.63±16.71) min(P <0.05)。术前,2组患者CRP、TNF-α、COR及ACTH等指标无明显差异(P> 0.05);术后,观察组CRP、TNF-α、COR及ACTH含量,明显低于对照组(P<0.05)。观察组并发症发生率为13.04%(9/69),明显低于对照组并发症发生率31.88%(22/69)(P <0.05)。结论与传统开胸手术相比,胸腔镜下微创术治疗恶性纵膈肿瘤具有患者术中出血量少、术后恢复时间短、并发症少及应激反应低等优势,值得临床推广。
Objective To analyze the contents of ACTH,RP,TNF-α,COR and other indicators,postoperative complications and prognosis of patients with malignant mediastinal tumor under video-assisted thoracoscopic surgery.Methods 138 patients with malignant mediastinal tumor in our hospital were randomly divided into the control group and the observation group.The control group was treated with traditional thoracotomy,while the observation group underwent video-assisted thoracoscopic surgery.Comparison of two groups of patients with treatment effect,recorded the operation time,intraoperative blood loss,postoperative pain time,postoperative hospital stay,VAS pain score and preoperative and postoperative CRP,ACTH,COR,TNF-αand other indicators.Results The effective rate of the observation group was 89.85%(62/69),which was significantly higher than that of the control group 73.91%(52/69)(P<0.05).The observation group of patients with loss of blood volume(42.98±9.52)ml,postoperative pain time(2.87±0.56)h,hospitalization time(8.21±1.59)d and pain score(3.94±0.67)was significantly less than the control quantity of bleeding group(90.34±18.17)ml,postoperative pain time(3.63±1.65)h,hospitalization time(14.48±3.06)d and pain score(7.55±3.12);but the observation group of patients with operation time(97.96±9.84)min were slightly higher than that of the control group(89.63±16.71)min(P<0.05).Before the operation,the 2 groups of patients before and after operation of CRP,TNF-α,COR and ACTH were no significant difference(P>0.05);after the operation,the observation group CRP(121.49±11.24)mg·d L~(-1),TNF-α(0.94±0.41)pg·ml~(-1),COR(114.86±15.95)ng·ml~(-1) and ACTH(2.91.0.42)ng·ml~(-1)were significantly lower than that of control group CRP(143.75±11.63)mg·d L~(-1),TNF-α(1.77±0.58)pg·ml~(-1),COR(138.42±16.23)ng·ml~(-1)and ACTH(4.11±0.98)ng·ml~(-1)(P<0.05).The complication rate of the observation group was 13.04%(9/69),which was significantly lower than that of the control group 31.88%(22/69)(P<0.05).Conclusion Compared with the traditional open chest surgery,thoracoscopic minimally invasive surgery in patients with malignant mediastinal tumors in the small amount of bleeding,postoperative recovery time,fewer complic ations and lower stress response,it is worthy of clinical promotion.
Objective To analyze the contents of ACTH,RP,TNF-α,COR and other indicators,postoperative complications and prognosis of patients with malignant mediastinal tumor under video-assisted thoracoscopic surgery.Methods 138 patients with malignant mediastinal tumor in our hospital were randomly divided into the control group and the observation group.The control group was treated with traditional thoracotomy,while the observation group underwent video-assisted thoracoscopic surgery.Comparison of two groups of patients with treatment effect,recorded the operation time,intraoperative blood loss,postoperative pain time,postoperative hospital stay,VAS pain score and preoperative and postoperative CRP,ACTH,COR,TNF-αand other indicators.Results The effective rate of the observation group was 89.85%(62/69),which was significantly higher than that of the control group 73.91%(52/69)(P<0.05).The observation group of patients with loss of blood volume(42.98±9.52)ml,postoperative pain time(2.87±0.56)h,hospitalization time(8.21±1.59)d and pain score(3.94±0.67)was significantly less than the control quantity of bleeding group(90.34±18.17)ml,postoperative pain time(3.63±1.65)h,hospitalization time(14.48±3.06)d and pain score(7.55±3.12);but the observation group of patients with operation time(97.96±9.84)min were slightly higher than that of the control group(89.63±16.71)min(P<0.05).Before the operation,the 2 groups of patients before and after operation of CRP,TNF-α,COR and ACTH were no significant difference(P>0.05);after the operation,the observation group CRP(121.49±11.24)mg·d L~(-1),TNF-α(0.94±0.41)pg·ml~(-1),COR(114.86±15.95)ng·ml~(-1) and ACTH(2.91.0.42)ng·ml~(-1)were significantly lower than that of control group CRP(143.75±11.63)mg·d L~(-1),TNF-α(1.77±0.58)pg·ml~(-1),COR(138.42±16.23)ng·ml~(-1)and ACTH(4.11±0.98)ng·ml~(-1)(P<0.05).The complication rate of the observation group was 13.04%(9/69),which was significantly lower than that of the control group 31.88%(22/69)(P<0.05).Conclusion Compared with the traditional open chest surgery,thoracoscopic minimally invasive surgery in patients with malignant mediastinal tumors in the small amount of bleeding,postoperative recovery time,fewer complic ations and lower stress response,it is worthy of clinical promotion.
引文
[1]王巍炜,李高峰,张勇,等.胸腔镜单操作孔切除纵隔肿瘤28例[J].中国微创外科杂志,2015,15(1):59-61.
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[5]张浩亮,赵松,侯智亮.胸腔镜在治疗胸腺疾病中的临床应用[J].中国老年学杂志,2015,35(12):3430-3431.
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[8]徐震壮,吴小波,胡斌.电视胸腔镜食管癌切除术[J].东南大学学报(医学版),2013,32(5):571-573.
[9]吴强,宋非无,黄河,等.胸腔镜手术对小儿纵隔肿瘤术后感染及疼痛应激相关血液指标的影响研究[J].中华医院感染学杂志,2017,27(4):927-930.
[10]王辉,史旭华,张文静,等.喉部病变对皮肌炎纵隔气肿患者预后影响的研究[J].临床耳鼻咽喉头颈外科杂志,2016,30(23):1870-1872.
[11]杨立,范翔宇,陆冬玲,等.胸腺瘤239例预后相关因素分析[J].中华肿瘤防治杂志,2016,23(18):1264-1267.
[12]丁仁泉,童向东,许世广,等.达芬奇机器人手术系统与电视胸腔镜在胸内纵隔疾病手术治疗中的对比研究[J].中国肺癌杂志,2014,17(7):557-562.
[13]Melfi FM,Fanucchi O,Mussi A.Minimally invasive mediastinal surgery[J].Ann Cardiothorac Surg,2016,5(1):10-17.
[14]杨胜利,茹婷巧,杨劼,等.单操作孔全胸腔镜手术在纵隔肿物切除中的应用[J].华中科技大学学报(医学版),2015,44(3):330-333.
[15]房渝,黄春,李军,等.完全电视胸腔镜手术诊治113例原发性纵隔肿瘤的临床分析[J].第三军医大学学报,2016,38(18):2087-2090.
[16]何丹,刘翼,吴振华,等.胸腹腔镜与传统开放手术治疗食管癌的围手术期疗效对比[J].中国癌症杂志,2016,26(11):932-938.
[2]许川,梅宏,韩连奎,等.电视胸腔镜手术治疗纵隔肿瘤41例报道[J].重庆医学,2015,44(3):403-405.
[3]Pecheva M,Mahendran K,Kadlec J,et al.Mediastinal giant parathyroid adenoma-a minimally invasive mediastinal surgical approach for an emergency presentation[J].Ann Cardiothorac Surg,2016,5(1):70-73.
[4]王领会,李玲,张艳燕,等.前纵隔肿瘤患者术后肺部感染的临床分析[J].中华医院感染学杂志,2014,24(22):5581-5583.
[5]张浩亮,赵松,侯智亮.胸腔镜在治疗胸腺疾病中的临床应用[J].中国老年学杂志,2015,35(12):3430-3431.
[6]Hauer J,Szlubowski A,6anowska K,et al.Minimally invasive strategy for mediastinal staging of patients with lung cancer[J].Polskie Archiwum Medycyny Wewnetrznej,2015,125(12):910.
[7]蒋连勇,谢晓,胡丰庆,等.单操作孔全胸腔镜手术在小儿后纵隔肿瘤中的应用[J].中国微创外科杂志,2015,15(10):876-877,882.
[8]徐震壮,吴小波,胡斌.电视胸腔镜食管癌切除术[J].东南大学学报(医学版),2013,32(5):571-573.
[9]吴强,宋非无,黄河,等.胸腔镜手术对小儿纵隔肿瘤术后感染及疼痛应激相关血液指标的影响研究[J].中华医院感染学杂志,2017,27(4):927-930.
[10]王辉,史旭华,张文静,等.喉部病变对皮肌炎纵隔气肿患者预后影响的研究[J].临床耳鼻咽喉头颈外科杂志,2016,30(23):1870-1872.
[11]杨立,范翔宇,陆冬玲,等.胸腺瘤239例预后相关因素分析[J].中华肿瘤防治杂志,2016,23(18):1264-1267.
[12]丁仁泉,童向东,许世广,等.达芬奇机器人手术系统与电视胸腔镜在胸内纵隔疾病手术治疗中的对比研究[J].中国肺癌杂志,2014,17(7):557-562.
[13]Melfi FM,Fanucchi O,Mussi A.Minimally invasive mediastinal surgery[J].Ann Cardiothorac Surg,2016,5(1):10-17.
[14]杨胜利,茹婷巧,杨劼,等.单操作孔全胸腔镜手术在纵隔肿物切除中的应用[J].华中科技大学学报(医学版),2015,44(3):330-333.
[15]房渝,黄春,李军,等.完全电视胸腔镜手术诊治113例原发性纵隔肿瘤的临床分析[J].第三军医大学学报,2016,38(18):2087-2090.
[16]何丹,刘翼,吴振华,等.胸腹腔镜与传统开放手术治疗食管癌的围手术期疗效对比[J].中国癌症杂志,2016,26(11):932-938.