Effect of video-assisted thoracoscopic lobectomy on cardiac and respiratory functions in elderly patients with non-small cell lung cancer
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摘要:目的 探讨电视胸腔镜辅助下肺叶切除术(VATS)对老年非小细胞肺癌(NSCLC)患者心功能和呼吸功能的影响。方法 将92例老年NSCLC患者随机分为对照组与观察组, 每组46例。对照组采用经典开胸肺叶切除术+纵膈淋巴结清扫治疗，观察组采用VATS治疗。比较2组手术相关指标、心功能指标[心率(HR)、脉搏氧饱和度(SpO2)]、呼吸功能指标[用力肺活量(FVC)、第1秒用力肺活量(FEV1)和最大通气量(MVV)]、并发症发生情况、住院时间及治疗费用。结果 2组手术均成功完成，观察组无中转开胸术者。2组手术时间、术中淋巴结清扫个数比较无显著差异(P>0.05), 观察组切口长度、术中出血量及留置引流时间均显著优于对照组(P < 0.01)。2组患者术前HR、SpO2、FVC、FEV1、MVV比较，差异均无统计学意义(P>0.05); 术后1周，除SpO2外, 2组其他指标与术前比较差异均有统计学意义(P < 0.05); 2组术后1周HR、FVC、FEV1、MVV比较，差异均有统计学意义(P < 0.05或P < 0.01)。观察组手术并发症发生率为6.52%, 低于对照组21.74%, 差异有统计学意义(P < 0.05)。观察组住院时间、医疗费用分别为(11.93±2.57) d、(3.06±0.58)万元人民币，均低于对照组的(13.62±3.14) d、(3.43±0.75)万元人民币，差异均有统计学意义(P < 0.01)。结论 采用VATS治疗老年NSCLC患者可取得与传统开胸肺叶切除术相近的手术效果，但VATS对患者心功能、呼吸功能影响较小，患者术后恢复快，并发症少，节约了医疗成本。
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关键词:
- 非小细胞肺癌 /
- 电视胸腔镜辅助下肺叶切除术 /
- 疗效 /
- 心功能 /
- 呼吸功能
Abstract:Objective To investigate the clinical efficacy of video-assisted thoracic surgery (VATS) in the treatment of elderly non-small cell lung cancer (NSCLC).Methods A total of 92 elderly patients with NSCLC admitted to our hospital were randomly divided into control group and observation group, with 46 cases in each group. The control group was treated with classical treatment of thoracotomy plus mediastinal lymph node dissection, while the observation group was treated with VATS. The operation-related indexes, cardiac function [heart rate, (HR), pulse oxygen saturation (SpO2)]and respiratory function indexes[forced vital capacity (FVC), forced expiratory volume in the first second(FEV1), maximal voluntary ventilation(MVV)]were compared between the two groups. The incidence of complications, hospital stay and expenses were compared.Results The operation was successfully completed in both groups, and no patients conversed to thoracotomy in the observation group. There were no significant differences in operation time and number of lymph node dissection between the two groups (P>0.05). Incision length, intraoperative bleeding volume and indwelling drainage time of the observation group were shorter than that of the control group(P < 0.01); but no differences were observed in HR, SpO2, FVC, FEV1, MVV of the two groups(P>0.05). The above indexes(except for SpO2) at 1 week after treatment of the two groups showed significant differences compared with treatment before(P < 0.05), and showed significant between-group differences(P < 0.05). The complication rate of the observation group was lower than that of the control group (6.52% vs. 21.74%, P < 0.05), and the hospitalization time and medical expenses were (11.93±2.57) d, (3.06±0.58) ten thousand RMB, which were significantly lower than (13.62±3.14) d, (3.43±0.75) ten thousand RMB(P < 0.05).Conclusion Video-assisted thoracoscopic lobectomy (VATS) for elderly patients with NSCLC can not only achieve the same effect as thoracotomy for resection of tumors, but also have the advantages of less impact on cardiac function and pulmonary respiratory function, rapid recovery and less complication, and lower medical costs. -
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表 1 2组患者手术相关指标比较(x±s)
组别 n 手术时间/min 切口长度/cm 术中出血量/mL 淋巴结清扫数/个 留置引流时间/d 对照组 46 118.22±14.19 13.75±2.14 273.47±35.41 13.21±3.46 7.25±1.56 观察组 46 122.07±12.68 6.23±1.05** 184.52±24.76** 13.07±3.28 4.86±1.34** 与对照组比较, **P < 0.01。 
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表 2 2组患者术前、术后1周的心功能、呼吸功能指标比较(x±s)
时点 组别 HR/(次/min) SpO2/% FVC/L FEV1/L MVV/L 术前 对照组 69.73±13.26 96.17±5.92 2.71±0.68 2.01±0.78 76.81±8.32 观察组 70.14±14.05 95.78±5.81 2.74±0.71 1.98±0.80 77.23±7.95 术后1周 对照组 93.10±10.72* 95.49±4.16 1.85±0.51* 1.43±0.45* 49.27±5.73* 观察组 83.56±9.76*## 95.18±4.30 2.14±0.62*# 1.67±0.62*# 53.38±6.29*## HR: 心率; SpO2: 脉搏氧饱和度; FVC: 用力肺活量; FEV1: 第1秒用力肺活量; MVV: 最大通气量。与术前比较, *P < 0.05; 与对照组比较, #P < 0.05, ##P < 0.01。
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表 3 2组患者手术相关并发症比较[n(%)]
组别 n 切口感染 胸腔积液 胸腔漏气 肺部感染 心房纤颤 其他 合计 对照组 46 2(4.35) 1(2.17) 0 2(4.35) 3(6.52) 2(4.35) 10(21.74) 观察组 46 0 1(2.17) 0 0 1(2.17) 1(2.17) 3(6.52)* 与对照组比较, *P < 0.05。
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