摘要目的 比较电视辅助胸腔镜和小切口开胸肺切除术治疗临床早期非小细胞肺癌(NSCLC)在手术损伤以及术后恢复的差异.方法 2004年3月至2006年12月将47例临床早期NSCLC患者随机分为胸腔镜组和小切口组手术.记录手术切口长度、手术时间和术中出血量.测定术前,术后4、24和48 h患者血浆IL-6和IL-10的水平.采用视觉模拟评分法于术前至术后第7天进行疼痛评分.于术前到术后第7天进行Karnofsky功能状态评分.结果 胸腔镜组切口长度(6.0±0.9)cm,小切口组(12.5±1.5)cm.手术时间、术中出血量两组差异均无统计学意义.术后第5～7天胸腔镜组疼痛较轻(P＜0.05).术后4、24和48 h血浆IL-6和IL-10的水平两组间差异均无统计学意义.术后第2～7天胸腔镜组Karnofsky功能状态评分较高(P＜0.01).结论 胸腔镜肺切除术比小切口手术疼痛轻,恢复快,但细胞因子反应无差异.

abstractsObjective To compare the differences of injuries and recovery between video-assisted thoracoscopic surgery(VATS)and mini-thoracotomy(MT)in patients with clinical early stage non-small cell lung cancer(NSCLC)after lobectomy.Methods From March 2004 to December 2006,47 consecutive patients with early stage NSCLC with a diameter of tumor less than 6 cm were recruited and randomized to VATS group and MT group.Incision length,duration of operation and intraoperative blood loss were recorded.Postoperative pain was assessed using a visual analogue scale before operation and daily for the first 7 days after operation.The serum levels of interleukin-6(IL-6)and interleukin-10(IL-10)were measured by cytometric bead array before operation and at 4,24,and 48 h after operation.Karnofsky performance status(KPS)was assessed before operation and daily for the first 7 days after operation.Results Incision length was(6.0±0.9)cm in the VATS group and(12.5±1.5)cm in the MT group.There was no significant difference in duration of operation and intraoperative blood loss between the VATS group and the MT group.Postoperative pain was significantly less in the VATS group in the 5th to 7th day postoperatively(P＜0.05).There was no significant difference of serum concentrations of IL-6 and IL-10 between the VATS group and the MT group at 4,24,and 48 h after operation.KPS score was significantly higher in the VATS group on 2nd to 7th day postoperatively(P＜0.05).Conclusion Compared with MT,VATS for lobectomy has less postoperative pain,faster recovery,but can't reduce postoperative release of cytokines.