海军医学杂志

目的 探讨全胸腔镜下肺叶切除术与小切口开胸肺叶切除术治疗非小细胞肺癌的临床效果，以及对血清癌胚抗原(CEA)、胸苷激酶1(TK1)和血气指标的影响。方法 纳入湖南医药学院总医院2017年4月至2019年3月收治的96例经病理检测诊断为非小细胞肺癌的患者，随机分为对照组与观察组，每组48例。观察组予全胸腔镜下肺叶切除术，对照组予开胸肺叶切除术，2组均予纵隔淋巴结清扫。比较2组患者围手术期指标及术后并发症发生率。分别于术前、术后采集患者静脉血，取血清后测定肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、CEA、TK1水平。比较术前、术后2组患者视觉模拟评分(VAS)及血气指标。随访24个月，记录2组患者在此期间的生存情况。结果 观察组手术时间、下床活动时间及住院时间均短于对照组，术中出血量少于对照组(P<0.05);2组患者清扫淋巴结数量相当(P>0.05)。术后2组患者血清PCT、hs-CRP、TNF-α水平均升高，观察组低于对照组(P均<0.05)。术后2组患者血氧分压(PaO2)、二氧化碳分压(PaCO2)、剩余碱(BE)水平均降低；组间相比，观察组PaO2水平高于对照组(P<0.05)。术后2组患者血清CEA、TK1水平均降低(P均<0.05)，组间相比差异无统计学意义(P>0.05)。术前2组患者VAS评分相当，术后1 d、3 d、7 d观察组均低于对照组(P<0.05)。观察组术后并发症发生率低于对照组(6.25%vs 22.92%,P<0.05)。随访24个月，2组患者生存率比较差异无统计学意义(P>0.05)。结论 全胸腔镜下肺叶切除术可有效减轻术后疼痛并降低对肺功能的损伤，缩短住院时间，减少并发症发生率，在疗效上与小切口开胸手术相当，兼具高效性与安全性，值得临床推广使用。

Objective To compare the efficacy of completely thoracoscopic lobectomy and small-incision thoracotomy for pulmonary lobectomy in the treatment of non-small cell lung cancer and the influence on serum carcinoembryonic antigen(CEA), thymidine kinase 1(TK1) and blood gas indexes.Methods From April 2017 to March 2019, 96 patients with non-small cell lung cancer diagnosed by pathological examination in Hunan University of Medicine General Hospital were randomly divided into control group and observation group, with 48 cases in each group. Completely thoracoscopic lobectomy was performed in the observation group, and thoracotomy for pulmonary lobectomy was performed in the control group. Mediastinal lymphadenectomy was given in both groups. The perioperative indexes and the incidence of postoperative complications were compared between the 2 groups. Venous blood was collected before and after the operation. The serum was collected to determine tumor necrosis factor-α(TNF-α), procalcitonin(PCT), hypersensitive C-reactive protein(hs-CRP), CEA, and TK1. The visual analogue scale(VAS) scores and radial artery blood gas indexes were compared between the 2 groups before and after surgery. The survival of the 2 groups was recorded during 2-year follow-up.Results The operative time, intraoperative blood loss, activity time out of bed and hospitalization time in the observation group were significantly lower than those in the control group(all P<0. 05). No significant difference was found in the number of dissected lymph nodes between the 2 groups(P>0. 05). Serum PCT, hs-CRP and TNF-α levels were increased after surgery in both groups, and these indexes in the observation group were significantly lower than those in the control group(all P<0. 05). Partial pressure of oxygen(PaO2), partial pressure of carbon dioxide(PaCO2) and base excess(BE) levels were decreased after surgery in both groups. Postoperative PaO2 in the observation group was significantly higher than that in the control group(P<0. 05). Serum CEA and TK1 levels in 2 groups after operation were significantly lower than those before operation(both P<0. 05), but there was no significant difference in the CEA or TK1 between the groups(P>0. 05). There was no significant difference in the preoperative VAS scores between the groups. The VAS scores on the 1st, 3rd, and 7th day after operation in the observation group were significantly lower than those in the control group(P<0. 05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group(6. 25% vs. 22. 92%, P<0. 05). After 24 months of follow-up, there was no significant difference in survival rate between the 2 groups(P>0. 05).Conclusion Completely thoracoscopic lobectomy can effectively reduce postoperative pain, improve lung function, shorten hospitalization time, and has fewer complications. Its therapeutic effect is equivalent to small-incision thoracotomy. It is worthy of clinical promotion with both high efficiency and safety.