Ji Deyu, Sun Ronggui, Wu Zhiyong
Department of Thoracic Surgery, Mingguang People's Hospital No. 379, Mingguang Avenue, Mingguang 239400, Anhui, China.
Am J Transl Res. 2023 Jun 15;15(6):4369-4379. eCollection 2023.
To determine the effects of uniportal thoracoscopic pulmonary segmentectomy and lobectomy on patients with early-stage non-small-cell lung cancer (ES-NSCLC) and risk factors of postoperative complications.
The clinical data of 97 patients with early lung cancer treated in Mingguang People's Hospital between October 2019 and December 2021 were retrospectively analyzed. A total of 45 patients who underwent pulmonary segmentectomy were assigned to the observation group. The remaining 52 patients who underwent lobectomy were assigned to the control group. The perioperative indexes of the two groups were compared, including operation time, intraoperative blood loss, intraoperative lymph node dissection, postoperative indwelling time of drainage tube and postoperative drainage volume. The treatment cost and hospitalization time of the two groups were compared. The changes of inflammatory indexes including C-reactive protein (CRP), interleukin (IL)-1β, IL-6, and tumour necrosis factor (TNF)-α before and after treatment were compared between the two groups. The changes of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were compared between the two groups. The incidence of postoperative complications in the two groups was counted. Logistic regression was conducted for analyzing the risk factors of postoperative complications.
The two groups were similar in operation time, intraoperative blood loss, and number of intraoperative lymph node dissected (all P>0.05). The observation group experienced a significantly shorter postoperative indwelling time of drainage tube and less postoperative drainage volume than the control group after surgery (P<0.05). The observation group presented significantly lower CRP, IL-1β, IL-6, and TNF-α levels than the control group (P<0.001). The observation group presented significantly higher FEV1 and FVC levels than the control group at 3 months after operation (P<0.001). The treatment cost of the two groups was not greatly different (P>0.05), but the observation group experienced a significantly shorter hospitalization time than the control group (P<0.001). The two groups were similar in the incidence of complications (P>0.05). According to multivariate logistics regression analysis, age, operation time, and number of lymph nodes dissected were independent risk factors for postoperative complications (P<0.05).
To sum up, for patients with early LC, pulmonary segmentectomy is significantly more effective than lobectomy in terms of pulmonary function and inflammatory response, and age, operation time and number of lymph node dissected during operation are independent risk factors affecting postoperative complications.
探讨单孔胸腔镜肺段切除术与肺叶切除术治疗早期非小细胞肺癌（ES-NSCLC）的效果及术后并发症的危险因素。
回顾性分析2019年10月至2021年12月在明光市人民医院接受治疗的97例早期肺癌患者的临床资料。将45例行肺段切除术的患者纳入观察组。其余52例行肺叶切除术的患者纳入对照组。比较两组的围手术期指标，包括手术时间、术中出血量、术中淋巴结清扫情况、术后引流管留置时间及术后引流量。比较两组的治疗费用和住院时间。比较两组治疗前后炎症指标包括C反应蛋白（CRP）、白细胞介素（IL）-1β、IL-6和肿瘤坏死因子（TNF）-α的变化。比较两组第1秒用力呼气量（FEV1）和用力肺活量（FVC）的变化。统计两组术后并发症的发生率。采用Logistic回归分析术后并发症的危险因素。
两组在手术时间、术中出血量及术中清扫淋巴结数量方面比较，差异均无统计学意义（均P>0.05）。术后观察组引流管留置时间明显短于对照组，术后引流量少于对照组（P<0.05）。观察组CRP、IL-1β、IL-6及TNF-α水平明显低于对照组（P<0.001）。术后3个月观察组FEV1和FVC水平明显高于对照组（P<0.001）。两组治疗费用差异无统计学意义（P>0.05），但观察组住院时间明显短于对照组（P<0.001）。两组并发症发生率比较，差异无统计学意义（P>0.05）。多因素Logistic回归分析显示，年龄、手术时间及清扫淋巴结数量是术后并发症的独立危险因素（P<0.05）。
综上所述，对于早期肺癌患者，肺段切除术在肺功能和炎症反应方面明显优于肺叶切除术，年龄、手术时间及术中清扫淋巴结数量是影响术后并发症的独立危险因素。
