非小细胞肺癌电视胸腔镜微创手术对患者心肺功能及预后影响
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摘要
目的非小细胞肺癌(non-small cell lung cancer,NSCLC)是肺癌常见类型,占肺癌总数约80%。本研究探讨NSCLC患者采用电视胸腔镜微创手术治疗对其心肺功能及预后的影响。方法选择2013-04-05-2015-04-10南阳市第二人民医院收治的94例NSCLC患者作为研究对象,选择电视胸腔镜微创手术治疗的47例患者为观察组,传统开胸手术治疗的47例患者为对照组,两组术后均随访3年,比较两组手术相关指标、心功能、肺功能、并发症率及生存率。结果观察组术中出血量为(158.54±29.65)mL,低于对照组的(226.49±35.64)mL,t=10.048,P<0.001;住院时间为(12.11±1.98)d,短于对照组的(14.21±2.06)d,t=5.039,P<0.001;引流管置留时间为(2.16±1.02)d,短于对照组的(3.89±1.11)d,t=7.868,P<0.001;观察组手术时间为(90.36±14.22)min,长于对照组的(82.95±15.31)min,t=2.431,P=0.017。术后1个月,观察组最大自主通气量(maximal voluntary ventilation,MVV)为(55.28±10.26)L,高于对照组的(50.32±9.68)L,t=2.411,P=0.018;第1秒用力呼气容积(forced expiratory volume in one second,FEV1)为(1.56±0.43)L,高于对照组的(1.37±0.41)L,t=2.192,P=0.031;用力肺活量(forced vital capacity,FVC)为(2.13±0.45)L,高于对照组的(1.80±0.39)L,t=3.799,P<0.001。观察组脉搏量(pulse volume,PV)为(69.49±8.74)mL,高于对照组的(64.26±8.65)mL,t=2.916,P=0.005;左室射血分数(left ventricular ejection fractions,LVEF)为(61.25±6.21)%,高于对照组的(54.68±6.03)%,t=5.204,P<0.001。观察组心率(heart rate,HR)为(73.26±6.85)次/min,低于对照组的(80.25±7.69)次/min,t=4.653,P<0.001。观察组并发症率为6.38%,低于对照组的21.28%,χ2=4.374,P=0.037;术后3年生存率为82.98%,高于对照组的63.83%,χ2=4.414,P=0.036。结论 NSCLC采用电视胸腔镜微创手术治疗可减轻机体创伤性,改善心、肺功能,降低并发症发生率,提高患者3年内生存率。
OBJECTIVE Non-small cell lung cancer(NSCLC)is a common type of lung cancer,accounting for about80% of the total number of lung cancers.This study explores the impact of video-assisted thoracoscopic minimally invasive surgery on cardiopulmonary function and prognosis in patients with NSCLC.METHODS A total of 94 patients with NSCLC admitted to the Second People's Hospital of Nanyang City from April 5,2013 to April 10,2015 were enrolled in the study.47 patients who underwent video-assisted thoracoscopic minimally invasive surgery were in observation group.Forty-seven patients underwent traditional surgical treatment as control.The two groups were followed up for 3 years.The surgical outcomes,cardiac function,pulmonary function,complication rate and survival rate were compared between the two groups.RESULTS The intraoperative blood loss of the observation group was(158.54±29.65)ml,which was lower than that of the control group(226.49±35.64)ml,t=10.048,P<0.001.The hospital stay was(12.11±1.98)d,which was lower than that of the control group(14.21±2.06)d,t=5.039,P<0.001.The drainage tube retention time was(2.16±1.02)d,which was lower than that of the control group(3.89±1.11)d,t=7.868,P<0.001.The operation time of the observation group was(90.36±14.22)min,which was longer than that of the control group(82.95±15.31)min,t=2.431,P=0.017.One month after operation,the maximal voluntary ventilation(MVV)of the observation group was(55.28±10.26)L,higher than(50.32±9.68)L of the control group,t=2.411,P=0.018.The forced expiratory volume in one second(FEV1)was(1.56±0.43)L,which was higher than that of the control group(1.37±0.41)L,t=2.192,P=0.031.The forced vital capacity(FVC)was(2.13±0.45)L,which was higher than that of the control group(1.80±0.39)L,t=3.799,P<0.001.The pulse volume(PV)of the observation group was(69.49±8.74)ml,which was higher than that of the control group(64.26±8.65)ml,t=2.916,P=0.005.The left ventricular ejection fractions(LVEF)were(61.25±6.21)%,which was higher than that of the control group(54.68±6.03)%,t=5.204,P<0.001.The heart rate(HR)of the observation group was(73.26±6.85)times/min,which was lower than that of the control group(80.25±7.69)times/min,t=4.653,P<0.001.The complication rate of the observation group was6.38%,which was lower than that of the control group(21.28%),χ2=4.374,P=0.037.The 3-year survival rate was82.98%,which was higher than that of the control group(63.83%),χ2=4.414,P=0.036.CONCLUSION The videoassisted thoracoscopic minimally invasive surgery of NSCLC can reduce the trauma of the body,improve cardiopulmonary function,reduce the incidence of complications,and improve the survival rate of patients within 3 years.
OBJECTIVE Non-small cell lung cancer(NSCLC)is a common type of lung cancer,accounting for about80% of the total number of lung cancers.This study explores the impact of video-assisted thoracoscopic minimally invasive surgery on cardiopulmonary function and prognosis in patients with NSCLC.METHODS A total of 94 patients with NSCLC admitted to the Second People's Hospital of Nanyang City from April 5,2013 to April 10,2015 were enrolled in the study.47 patients who underwent video-assisted thoracoscopic minimally invasive surgery were in observation group.Forty-seven patients underwent traditional surgical treatment as control.The two groups were followed up for 3 years.The surgical outcomes,cardiac function,pulmonary function,complication rate and survival rate were compared between the two groups.RESULTS The intraoperative blood loss of the observation group was(158.54±29.65)ml,which was lower than that of the control group(226.49±35.64)ml,t=10.048,P<0.001.The hospital stay was(12.11±1.98)d,which was lower than that of the control group(14.21±2.06)d,t=5.039,P<0.001.The drainage tube retention time was(2.16±1.02)d,which was lower than that of the control group(3.89±1.11)d,t=7.868,P<0.001.The operation time of the observation group was(90.36±14.22)min,which was longer than that of the control group(82.95±15.31)min,t=2.431,P=0.017.One month after operation,the maximal voluntary ventilation(MVV)of the observation group was(55.28±10.26)L,higher than(50.32±9.68)L of the control group,t=2.411,P=0.018.The forced expiratory volume in one second(FEV1)was(1.56±0.43)L,which was higher than that of the control group(1.37±0.41)L,t=2.192,P=0.031.The forced vital capacity(FVC)was(2.13±0.45)L,which was higher than that of the control group(1.80±0.39)L,t=3.799,P<0.001.The pulse volume(PV)of the observation group was(69.49±8.74)ml,which was higher than that of the control group(64.26±8.65)ml,t=2.916,P=0.005.The left ventricular ejection fractions(LVEF)were(61.25±6.21)%,which was higher than that of the control group(54.68±6.03)%,t=5.204,P<0.001.The heart rate(HR)of the observation group was(73.26±6.85)times/min,which was lower than that of the control group(80.25±7.69)times/min,t=4.653,P<0.001.The complication rate of the observation group was6.38%,which was lower than that of the control group(21.28%),χ2=4.374,P=0.037.The 3-year survival rate was82.98%,which was higher than that of the control group(63.83%),χ2=4.414,P=0.036.CONCLUSION The videoassisted thoracoscopic minimally invasive surgery of NSCLC can reduce the trauma of the body,improve cardiopulmonary function,reduce the incidence of complications,and improve the survival rate of patients within 3 years.
引文
[1]徐宝宁,宋成洋,邹孔军,等.电视胸腔镜辅助微创切口肺癌根治术治疗非小细胞肺癌的临床效果[J].山东医药,2015,55(37):4-6.
[2]谷彪.电视胸腔镜手术对非小细胞肺癌患者预后改善的效果观察[J].临床肺科杂志,2016,21(7):1347-1349.
[3]赵纯诚,郭志强,王征.微创手术对老年非小细胞肺癌患者心肺功能的影响[J].实用癌症杂志,2015,30(1):82-85.
[4]Yan TD,Cao C,D'Amico TA,et al.Video-assisted thoracoscopic surgery lobectomy at 20years:A consensus statement[J].Eur J Cardiothorac Surg,2014,45(4):633-639.
[5]徐卫华,陈勇兵,蒋堪秋,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响[J].中华老年医学杂志,2015,34(5):510-511.
[6]杨世兵,胡杰伟,周海宁.胸腔镜手术与传统开胸手术对非小细胞肺癌患者心肺功能的影响及疗效分析[J].实用癌症杂志,2017,32(6):969-971.
[7]徐月亮,王孝彬,韩勇.早期非小细胞肺癌经电视胸腔镜和开胸手术治疗疗效的Meta分析[J].肿瘤学杂志,2016,22(7):583-588.
[8]Feng M,Shen Y,Wang H,et al.Uniportal video assisted thoracoscopic lobectomy:Primary experience from an Eastern center[J].J Thorac Dis,2014,6(12):1751-1756.
[9]樊纪丹,王霄霖,杨岷,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响[J].陕西医学杂志,2017,46(10):1375-1376.
[10]张宁,马丽斌,魏立,等.电视胸腔镜辅助小切口与开胸手术治疗原发性非小细胞肺癌的疗效对比[J].实用临床医药杂志,2016,20(9):97-100.
[11]任丹,涂启敏.电视胸腔镜术与开胸肺叶切除术对早期非小细胞肺癌患者炎症因子及免疫功能的影响[J].标记免疫分析与临床,2016,23(11):1330-1333.
[12]杨欣,曾兴建,付娟.电视胸腔镜与传统手术对治疗非小细胞肺癌患者心肺功能影响分析[J].临床和实验医学杂志,2016,15(11):1087-1089.
[13]张卫强,左建新,谭健,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响分析[J].中国全科医学,2014,17(2):220-222.
[14]朱启航,肖海平,何哲,等.3种电视胸腔镜下手术治疗非小细胞肺癌早期创伤反应的比较[J].实用医学杂志,2016,32(2):231-235.
[15]罗世忠,李明军.电视胸腔镜手术治疗非小细胞肺癌的疗效观察[J].临床肺科杂志,2014,19(1):116-118.
[16]张皓,齐海,王磊,等.电视胸腔镜与开胸手术治疗非小细胞肺癌随机对照研究的系统评价和Meta分析[J].中国胸心血管外科临床杂志,2015,24(12):1087-1094.
[2]谷彪.电视胸腔镜手术对非小细胞肺癌患者预后改善的效果观察[J].临床肺科杂志,2016,21(7):1347-1349.
[3]赵纯诚,郭志强,王征.微创手术对老年非小细胞肺癌患者心肺功能的影响[J].实用癌症杂志,2015,30(1):82-85.
[4]Yan TD,Cao C,D'Amico TA,et al.Video-assisted thoracoscopic surgery lobectomy at 20years:A consensus statement[J].Eur J Cardiothorac Surg,2014,45(4):633-639.
[5]徐卫华,陈勇兵,蒋堪秋,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响[J].中华老年医学杂志,2015,34(5):510-511.
[6]杨世兵,胡杰伟,周海宁.胸腔镜手术与传统开胸手术对非小细胞肺癌患者心肺功能的影响及疗效分析[J].实用癌症杂志,2017,32(6):969-971.
[7]徐月亮,王孝彬,韩勇.早期非小细胞肺癌经电视胸腔镜和开胸手术治疗疗效的Meta分析[J].肿瘤学杂志,2016,22(7):583-588.
[8]Feng M,Shen Y,Wang H,et al.Uniportal video assisted thoracoscopic lobectomy:Primary experience from an Eastern center[J].J Thorac Dis,2014,6(12):1751-1756.
[9]樊纪丹,王霄霖,杨岷,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响[J].陕西医学杂志,2017,46(10):1375-1376.
[10]张宁,马丽斌,魏立,等.电视胸腔镜辅助小切口与开胸手术治疗原发性非小细胞肺癌的疗效对比[J].实用临床医药杂志,2016,20(9):97-100.
[11]任丹,涂启敏.电视胸腔镜术与开胸肺叶切除术对早期非小细胞肺癌患者炎症因子及免疫功能的影响[J].标记免疫分析与临床,2016,23(11):1330-1333.
[12]杨欣,曾兴建,付娟.电视胸腔镜与传统手术对治疗非小细胞肺癌患者心肺功能影响分析[J].临床和实验医学杂志,2016,15(11):1087-1089.
[13]张卫强,左建新,谭健,等.电视胸腔镜手术对老年非小细胞肺癌患者术后心肺并发症的影响分析[J].中国全科医学,2014,17(2):220-222.
[14]朱启航,肖海平,何哲,等.3种电视胸腔镜下手术治疗非小细胞肺癌早期创伤反应的比较[J].实用医学杂志,2016,32(2):231-235.
[15]罗世忠,李明军.电视胸腔镜手术治疗非小细胞肺癌的疗效观察[J].临床肺科杂志,2014,19(1):116-118.
[16]张皓,齐海,王磊,等.电视胸腔镜与开胸手术治疗非小细胞肺癌随机对照研究的系统评价和Meta分析[J].中国胸心血管外科临床杂志,2015,24(12):1087-1094.