Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
J Cardiothorac Surg. 2023 Jul 6;18(1):218. doi: 10.1186/s13019-023-02307-0.
Postoperative patients with lung cancer mostly experience different degrees of dyspnea and decreased activity tolerance, and these symptoms all significantly affect postoperative quality of life. The concept of pulmonary rehabilitation applicable to patients with chronic respiratory diseases is also applicable to patients with postoperative lung cancer. The current application of postoperative pulmonary rehabilitation for lung cancer is inconsistent, and reliable guidelines are lacking. The purpose of this study was to further verify the efficacy and feasibility of postoperative pulmonary rehabilitation for lung cancer patients, and to find a suitable local pulmonary rehabilitation program for postoperative patients with lung cancer that is clinically promoted in our department through this study.
We collected the clinical data of patients undergoing video-assisted thoracoscopic surgery (VATS) wedge resection or lobectomy. The patients were divided into rehabilitation group (using three-ball breathing apparatus after discharge) and control group (routine follow-up after discharge) according to whether the patients were trained with three-ball breathing apparatus after operation. The detailed method using three-ball apparatus is as follows. To begin with, patients are required to put themselves in a comfortable position. Then, after the three-ball breathing apparatus put on the same plane of their eyes, patients hold the tube in their mouth closely and control their breath slowly. When patients inhale to their largest extent, the balls will rise up accordingly. Then they exhale. The evaluation results of pulmonary function, activity tolerance, anxiety scores and others were collected. All data was gathered at the First Affiliated Hospital of Soochow University. The effects of pulmonary rehabilitation training on wedge resection and lobectomy were compared.
A total of 210 patients were included in this study, including 126 patients with VATS wedge resection and 84 patients with VATS lobectomies. No discrepancy was noticed when FEV loss between two groups were compared in the wedge resection patients, and the same results were also shown in patients undergoing lobectomy (12.8% ± 2.0% vs. 12.7% ± 1.9%, P = 0.84, wedge resection; 12.6% ± 2.9% vs. 12.1% ± 1.8%, P = 0.37, lobectomy). The loss of FVC in the control group was greater than that in the rehabilitation group for patients undergoing lobectomy (11.7% ± 5.2%, vs. 17.1% ± 5.6%, P < 0.001, lobectomy). No difference was found in the wedge resection patients between the control and rehabilitation groups (6.6% ± 2.8%, vs. 6.4% ± 3.2%, P = 0.76, lobectomy). Moreover, all patients showed no significant difference in 6MWD regardless of surgical procedure and with or without breathing exercises at T3 (392.6 ± 50.6 m, rehabilitation group vs. 394.0 ± 46.6 m, control group. P = 0.87, wedge resection; 381.3 ± 38.9 m, rehabilitation group vs. 369.1 ± 49.3 m, control group. P = 0.21, lobectomy).
For patients after thoracoscopic pulmonary wedge resection, the use of three-ball apparatus did not significantly improve postoperative pulmonary function and activity tolerance, dyspnea, and anxiety symptoms. In patients after thoracoscopic lobectomy, respiratory trainers were able to improve postoperative lung function but were unable to significantly improve dyspnea and anxiety symptoms. There was a significant benefit for the use of three-ball apparatus in patients after thoracoscopic lobectomy, whereas there was no significant benefit for the use of respiratory trainers after wedge resection. Registry: Medical Ethics Committee of the First Affiliated Hospital of Soochow University.
no. 2022455.
肺癌术后患者多有不同程度的呼吸困难和活动耐力下降，这些症状均明显影响术后生活质量。适用于慢性呼吸系统疾病患者的肺康复理念也适用于肺癌术后患者。目前肺癌术后肺康复的应用并不一致，缺乏可靠的指南。本研究旨在进一步验证肺癌术后肺康复的疗效和可行性，并通过本研究为我科寻找适合术后肺癌患者的局部肺康复方案，在临床上进行推广。
收集行电视辅助胸腔镜手术（VATS）楔形切除术或肺叶切除术患者的临床资料。根据患者术后是否使用三球呼吸仪训练，将患者分为康复组（出院后使用三球呼吸仪）和对照组（出院后常规随访）。三球仪的详细使用方法如下。首先，患者需采取舒适的体位。然后，将三球呼吸仪置于与患者眼睛同一平面上，患者将管含在口中，控制缓慢呼吸。当患者吸气到最大程度时，球会相应上升。然后呼气。收集肺功能、活动耐力、焦虑评分等评估结果。所有数据均在苏州大学第一附属医院采集。比较肺康复训练对楔形切除术和肺叶切除术的影响。
本研究共纳入 210 例患者，其中 VATS 楔形切除术患者 126 例，VATS 肺叶切除术患者 84 例。楔形切除术患者中，两组 FEV 损失比较无差异，肺叶切除术患者也得到了同样的结果（12.8%±2.0%比 12.7%±1.9%，P=0.84；12.6%±2.9%比 12.1%±1.8%，P=0.37）。对照组肺叶切除术患者 FVC 损失大于康复组（11.7%±5.2%比 17.1%±5.6%，P<0.001）。楔形切除术患者对照组与康复组间差异无统计学意义（6.6%±2.8%比 6.4%±3.2%，P=0.76）。此外，无论手术方式如何，无论患者是否进行呼吸锻炼，所有患者在 T3 时 6MWD 均无显著差异（392.6±50.6 m，康复组比对照组；394.0±46.6 m，P=0.87，楔形切除术；381.3±38.9 m，康复组比对照组；369.1±49.3 m，P=0.21，肺叶切除术）。
对于接受电视辅助胸腔镜肺楔形切除术的患者，使用三球仪不能显著改善术后肺功能和活动耐力、呼吸困难和焦虑症状。对于接受电视辅助胸腔镜肺叶切除术的患者，呼吸训练器可以改善术后肺功能，但不能显著改善呼吸困难和焦虑症状。在电视辅助胸腔镜肺叶切除术后患者中使用三球仪有明显获益，而在楔形切除术后患者中使用呼吸训练器则无明显获益。注册号：苏州大学第一附属医院医学伦理委员会。注册号：2022455。
