全胸腔镜肺叶切除术治疗老年人非小细胞肺癌的疗效观察
Effect of thoracoscopic lobectomy in the treatment of elderly patients with non small cell lung cancer
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1 d[(7.57±1.63)分比(8.76±2.06)分]、3 d[(5.46±0.82)分比(6.68±1.53)分]、7 d[(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%)(χ2=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.
更多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 (1290.28 ±129.37)mL in the study group,which was less than (1643.19 ±231.27)mL in the control group.The operation time and hospitalization time of the study group were (145.72 ±19.65) min, (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 icant 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.11.67%,χ2 =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 cardiopulmonary 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 .
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