Yao Yuanshan, Shen Haibo, Zhou Yinjie, Yang Zhenhua, Huang Hongbo
Department of Thoracic Surgery, Ningbo No. 2 Hospital, Haishu, Ningbo, Zhejiang 315000, P.R. China.
Oncol Lett. 2018 Apr;15(4):4397-4403. doi: 10.3892/ol.2018.7839. Epub 2018 Jan 22.
The aim of this study was to investigate the feasibility and safety of thoracoscopic surgery in the treatment of lung cancer and its effect on serum D-dimer. A total of 218 patients with lung cancer treated in the Department of Thoracic Surgery of Ningbo No. 2 Hospital from January 1, 2013 to December 31, 2016, were retrospectively analyzed. Of the 218 patients, 120 patients underwent thoracotomy (thoracotomy group) and 98 patients underwent thoracoscopic surgery (thoracoscopy group). The clinical efficacy in the perioperative period and serum D-dimer level were compared between the two groups. In the present study, the intraoperative blood loss, blood transfusion rate, postoperative hospital stay, thoracic drainage time and volume in the thoracoscopy group were significantly shorter or smaller than those in the thoracotomy group (P<0.05), but there was no statistically significant difference in the average operation time between the thoracoscopy and the thoracotomy group. The incidence rate from moderate to severe pains in incisions after operation, the use rate of analgesics and the average disappearance time of the pain in incisions in the thoracoscopy were lower than those in the thoracotomy group (P<0.05). The amount of serum D-dimer immediately after operation in the thoracotomy group was significantly increased compared with that before operation (P<0.05), but there was no significant increase in the thoracoscopy group. At 24 h after operation, the serum D-dimer level in the two groups was further increased (P<0.05), and the comparison between the two groups showed that the levels of serum D-dimer in the thoracoscopy group immediately and at 24 h after operation were significantly lower than those in the thoracotomy group (P<0.05). The incidence rate of postoperative complications in the thoracoscopy was lower than that in the thoracotomy group, but the difference was not statistically significant. Our results show that thoracoscopic surgery is feasible and safe in the treatment of lung cancer. Compared with the thoracotomy group, the intraoperative condition and postoperative recovery have obvious advantages. The postoperative blood of patients is hypercoagulable and D-dimer increased gradually after 24 h. The effect of thoracoscopic surgery on serum D-dimer is relatively less effective.
本研究旨在探讨胸腔镜手术治疗肺癌的可行性、安全性及其对血清D - 二聚体的影响。回顾性分析2013年1月1日至2016年12月31日在宁波市第二医院胸外科治疗的218例肺癌患者。218例患者中，120例行开胸手术（开胸组），98例行胸腔镜手术（胸腔镜组）。比较两组围手术期临床疗效及血清D - 二聚体水平。本研究中，胸腔镜组术中出血量、输血率、术后住院时间、胸腔引流时间及引流量均明显短于或少于开胸组（P<0.05），但胸腔镜组与开胸组平均手术时间差异无统计学意义。胸腔镜组术后切口中度至重度疼痛发生率、镇痛药使用率及切口疼痛平均消失时间均低于开胸组（P<0.05）。开胸组术后即刻血清D - 二聚体含量较术前明显升高（P<0.05），而胸腔镜组无明显升高。术后24小时，两组血清D - 二聚体水平进一步升高（P<0.05），两组比较显示胸腔镜组术后即刻及术后24小时血清D - 二聚体水平明显低于开胸组（P<0.05）。胸腔镜组术后并发症发生率低于开胸组，但差异无统计学意义。我们的结果表明胸腔镜手术治疗肺癌是可行且安全的。与开胸组相比，术中情况及术后恢复具有明显优势。患者术后血液呈高凝状态，术后24小时后D - 二聚体逐渐升高。胸腔镜手术对血清D - 二聚体的影响相对较小。
