单操作孔全胸腔镜肺叶切除术对肺癌患者肺功能及血流动力学的影响
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摘要
目的探讨单操作孔全胸腔镜肺叶切除术对肺癌患者肺功能及血流动力学的影响。方法选取我院2016年5月至2018年6月收治的56例肺癌患者为研究对象,根据手术操作方式不同将其分为观察组和对照组,各28例。观察组采用单操作孔全胸腔镜肺叶切除术,对照组采取经典"三孔法"胸腔镜肺叶切除术。比较两组患者术前、术后3个月肺功能指标水平以及术中血流动力学指标水平。结果术前,两组患者的FEV_1、FVC、VC水平比较,差异无统计学意义(P>0.05);术后3个月,两组患者的FEV_1、FVC、VC水平均升高,且观察组高于对照组,差异具有统计学意义(P<0.05)。两组患者在麻醉诱导后的T_2~T_5,两组患者的MAP、HR、CO、SV水平均有波动,且观察组的波动小于对照组,差异具有统计学意义(P<0.05)。结论单操作孔全胸腔镜肺叶切除术更有助于改善肺癌患者术后肺功能,并对其术中血流动力学指标水平影响较小。
Objective To investigate the effect of single utility port complete thoracoscope lobectomy on pulmonary function and hemodynamics in patients with lung cancer. Methods Fifty-six patients with lung cancer admitted in our hospital from May 2016 to June 2018 were selected as the research objects and divided into observation group and control group according to different operation modes, with 28 cases in each group. The observation group was treated with single utility port complete thoracoscope lobectomy, while the control group was treated with classical "three-hole" thoracoscopic lobectomy. The levels of pulmonary function indexes before and 3 months after operation and levels of intraoperative hemodynamic indexes in the two groups were compared. Results Before operation, there were no significant differences in the levels of FEV_1, FVC and VC between the two groups(P>0.05); three months after operation, the levels of FEV_1, FVC and VC in the two groups increased, and those of the observation group were higher than the control group, and the differences were statistically significant(P<0.05). The levels of MAP, HR, CO and SV in the two groups fluctuated from T_2 to T_5 after anesthesia induction, and the fluctuating levels of the observation group were less than the control group, and the differences were statistically significant(P<0.05). Conclusion Single utility port complete thoracoscope lobectomy is more helpful to improve the pulmonary function of patients with lung cancer after operation, and has less influence on the levels of intraoperative hemodynamic indexes.
Objective To investigate the effect of single utility port complete thoracoscope lobectomy on pulmonary function and hemodynamics in patients with lung cancer. Methods Fifty-six patients with lung cancer admitted in our hospital from May 2016 to June 2018 were selected as the research objects and divided into observation group and control group according to different operation modes, with 28 cases in each group. The observation group was treated with single utility port complete thoracoscope lobectomy, while the control group was treated with classical "three-hole" thoracoscopic lobectomy. The levels of pulmonary function indexes before and 3 months after operation and levels of intraoperative hemodynamic indexes in the two groups were compared. Results Before operation, there were no significant differences in the levels of FEV_1, FVC and VC between the two groups(P>0.05); three months after operation, the levels of FEV_1, FVC and VC in the two groups increased, and those of the observation group were higher than the control group, and the differences were statistically significant(P<0.05). The levels of MAP, HR, CO and SV in the two groups fluctuated from T_2 to T_5 after anesthesia induction, and the fluctuating levels of the observation group were less than the control group, and the differences were statistically significant(P<0.05). Conclusion Single utility port complete thoracoscope lobectomy is more helpful to improve the pulmonary function of patients with lung cancer after operation, and has less influence on the levels of intraoperative hemodynamic indexes.
引文
[1]钱俊,周超,沈宇舟,等.钟表盘综合定位法单操作孔胸腔镜在高龄(≥70岁)肺肿瘤患者中的应用[J].中国微创外科杂志,2018,18(5):397-400.
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[8]陈聪,徐志峰,蔡绍环,等.单操作孔全胸腔镜手术方式对纵隔肿瘤患者近远期疗效的影响[J].检验医学与临床,2017,14(4):503-505.
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[11]陈劭赓,李旭,何荣琦,等.全胸腔镜肺叶切除术对肥胖低肺功能肺癌患者心肺功能的影响[J].实用癌症杂志,2017,32(2):286-288.
[12] KENT M S,MANDREKAR S J,LANDRENEAU R,et al.Impact of sublobar resection on pulmonary function:long-term results from american college of surgeons oncology group Z4032(Alliance)[J].Ann Thorac Surg,2016,102(1):230-238.
[13] PAG魬S PB,DELPY JP,ORSINI B,et al.Propensity score analysis comparing videothoracoscopic lobectomy with thoracotomy:a French nationwide study[J].Ann Thorac Surg,2016,101(4):1370-1378.
[14]魏合成,张海霞.全胸腔镜肺叶切除治疗肺癌的临床效果及对患者免疫功能、炎性因子和生存质量的影响[J].河北医药,2016,38(11):1688-1690.
[15]汤轶,陈跃军,邹求益.全胸腔镜肺叶切除术与开胸手术治疗非小细胞肺癌临床效果对比研究[J].临床医学,2016,36(12):79-81.
[16]水清.全胸腔镜肺叶切除术与传统开胸手术治疗非小细胞肺癌患者疗效对比[J].中国卫生标准管理,2016,7(15):77-78.
[17]曹纪伟,朱红军.单孔全胸腔镜肺叶切除术中不同胸腔引流方案对引流效果、疼痛程度及引流相关并发症的影响[J].腹腔镜外科杂志,2018,23(1):44-47.
[18]李晓平,任海霞,王旭晖,等.老年患者全胸腔镜肺叶切除术后去止血治疗的安全性研究[J].现代生物医学进展,2016,16(20):3869-3872.
[19]张帆,彭华利,赵飞,等.全胸腔镜下肺叶切除术在早期非小细胞肺癌治疗中的疗效及安全性[J].海军医学杂志,2017,38(1):33-34.
[2]江海峰,蒋连勇,谢晓,等.单操作孔全胸腔镜手术在儿童纵隔肿瘤中的应用[J].临床外科杂志,2016,24(4):299-301.
[3]黄同海,王光锁,丁光贵,等.单孔全胸腔镜手术后不置胸管治疗年轻患者自发性气胸[J].中国微创外科杂志,2016,16(6):535-537.
[4]陈晓涛,吴晓云.单操作孔全胸腔镜下肺叶切除术治疗肺癌的临床效果观察[J].实用心脑肺血管病杂志,2015,23(4):104-106.
[5]张明远,尉连成,樊海.单操作孔全胸腔镜下手术治疗自发性气胸70例体会[J].中国药物与临床,2015,15(12):1759-1760.
[6] LIU Z,YANG R,SHAO F,et al.Modified procedure of uniportal video-assisted thoracoscopic lobectomy with muscle sparing incision[J].Ann Transl Med,2016,4(19):367.
[7]丁长柏,卢庆国,王健.全胸腔镜肺叶切除与传统开胸肺叶切除治疗早期非小细胞肺癌的疗效比较[J].基层医学论坛,2017,21(34):4810-4812.
[8]陈聪,徐志峰,蔡绍环,等.单操作孔全胸腔镜手术方式对纵隔肿瘤患者近远期疗效的影响[J].检验医学与临床,2017,14(4):503-505.
[9]殷勇,张小康.全胸腔镜肺叶切除术与传统开胸手术治疗早期非小细胞肺癌的疗效分析[J].实用癌症杂志,2016,31(7):1137-1139.
[10]周亚夫,颜建华,冯键,等.全胸腔镜肺叶切除术与传统开放式肺叶切除术在Ⅰ、Ⅱ期肺癌治疗中的对比研究[J].中国临床医生杂志,2016,44(4):62-64.
[11]陈劭赓,李旭,何荣琦,等.全胸腔镜肺叶切除术对肥胖低肺功能肺癌患者心肺功能的影响[J].实用癌症杂志,2017,32(2):286-288.
[12] KENT M S,MANDREKAR S J,LANDRENEAU R,et al.Impact of sublobar resection on pulmonary function:long-term results from american college of surgeons oncology group Z4032(Alliance)[J].Ann Thorac Surg,2016,102(1):230-238.
[13] PAG魬S PB,DELPY JP,ORSINI B,et al.Propensity score analysis comparing videothoracoscopic lobectomy with thoracotomy:a French nationwide study[J].Ann Thorac Surg,2016,101(4):1370-1378.
[14]魏合成,张海霞.全胸腔镜肺叶切除治疗肺癌的临床效果及对患者免疫功能、炎性因子和生存质量的影响[J].河北医药,2016,38(11):1688-1690.
[15]汤轶,陈跃军,邹求益.全胸腔镜肺叶切除术与开胸手术治疗非小细胞肺癌临床效果对比研究[J].临床医学,2016,36(12):79-81.
[16]水清.全胸腔镜肺叶切除术与传统开胸手术治疗非小细胞肺癌患者疗效对比[J].中国卫生标准管理,2016,7(15):77-78.
[17]曹纪伟,朱红军.单孔全胸腔镜肺叶切除术中不同胸腔引流方案对引流效果、疼痛程度及引流相关并发症的影响[J].腹腔镜外科杂志,2018,23(1):44-47.
[18]李晓平,任海霞,王旭晖,等.老年患者全胸腔镜肺叶切除术后去止血治疗的安全性研究[J].现代生物医学进展,2016,16(20):3869-3872.
[19]张帆,彭华利,赵飞,等.全胸腔镜下肺叶切除术在早期非小细胞肺癌治疗中的疗效及安全性[J].海军医学杂志,2017,38(1):33-34.