胸腔镜肺叶切除术治疗非小细胞肺癌患者的效果及对炎性因子水平的影响

夏少锋 熊家俊 朱学雨 陈乐 张世浩

【摘要】 目的：探讨非小细胞肺癌患者应用胸腔镜肺叶切除术治疗的效果及对炎性因子水平的影响。方法：选取2018年5月-2019年5月本院96例非小细胞肺癌患者，依据治疗方法不同分为对照组和研究组，每组48例。对照组应用常规开胸肺叶切除术，研究组应用胸腔镜肺叶切除术。比较两组手术前后的炎性因子（IL-6、CRP、TNF-α、IL-8）、免疫球蛋白（IgM、IgG、IgA）水平、T细胞亚群（CD4+、CD8+、CD4+/CD8+）水平;比较两组手术时长、术中出血量、住院时长、术后置管引流时间、转移率、复发率。结果：术前，两组IL-6、CRP、TNF-α、IL-8水平比较，差异均无统计学意义（P>0.05）;术后，研究组IL-6、CRP、TNF-α、IL-8水平均低于对照组，差异均有统计学意义（P<0.05）。研究组手术时长、住院时长、术后置管引流时间均短于对照组，术中出血量少于对照组，差异均有统计学意义（P<0.05）。术前，两组IgM、IgG、IgA、CD4+、CD8+、CD4+/CD8+水平比较，差异均无统计学意义（P>0.05）;术后，两组IgM、IgG、IgA、CD4+、CD8+、CD4+/CD8+水平均低于术前，且研究组均高于对照组，差异均有统计学意义（P<0.05）。研究组转移率、复发率均低于对照组，差异均有统计学意义（P<0.05）。结论：非小细胞癌患者应用胸腔镜肺叶切除术治疗效果更佳，可以有效缩短手术时长、住院时长，降低术中出血量和机体中的炎性因子水平，提高患者的免疫功能，降低轉移率、复发率，值得推广和应用。

【关键词】 非小细胞肺癌 胸腔镜肺叶切除术 炎性因子

The Effect of Thoracoscopic Lobectomy in the Treatment of Patients with Non-small Cell Lung Cancer and Its Influence on the Level of Inflammatory Factors/XIA Shaofeng， XIONG Jiajun， ZHU Xueyu， CHEN Le， ZHANG Shihao. //Medical Innovation of China， 2021， 18（30）： 005-009

[Abstract] Objective： To explore the effect of thoracoscopic lobectomy in patients with non-small cell lung cancer and its influence on the level of inflammatory factors. Method： A total of 96 patients with non-small cell lung cancer in our hospital from May 2018 to May 2019 were selected， they were divided into control group and study group according to different treatment methods， 48 cases in each group. The control group received conventional thoracotomy and the study group received thoracoscopic lobectomy. The levels of inflammatory factors （IL-6， CRP， TNF-α， IL-8）， immunoglobulin （IgM， IgG， IgA） and T cell subsets （CD4+， CD8+， CD4+/CD8+） before and after surgery were compared between two groups; surgical time， intraoperative blood loss， length of hospital stay， postoperative catheter drainage time， metastasis rate， recurrence rate were compared between two groups. Result： Before surgery， there were no significant differences in IL-6， CRP， TNF-α and IL-8 levels between two groups （P>0.05）; after surgery， the levels of IL-6， CRP， TNF-α and IL-8 in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. The surgical time， length of hospital stay， postoperative catheter drainage time in the study group were shorter than those in the control group， and the intraoperative blood loss in the study group was less than that in the control group， the differences were statistically significant （P<0.05）. Before surgery， there were no significant differences in IgM， IgG， IgA， CD4+， CD8+， CD4+/CD8+

levels between two groups （P>0.05）; after surgery， the levels of IgM， IgG， IgA， CD4+， CD8+， CD4+/CD8+ in both groups were lower than those before surgery， and those in the study group were higher than those in the control group， the differences were statistically significant （P<0.05）. The metastasis rate and recurrence rate in the study group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： Thoracoscopic lobectomy for patients with non-small cell carcinoma has a better therapeutic effect， which can effectively shorten the duration of surgery and hospital stay， reduce intraoperative blood loss and the level of inflammatory factors in the body， improve the immune function of patients， reduce the rate of metastasis and recurrence， which is worthy of promotion and application.

[Key words] Non-small cell lung cancer Thoracoscopic lobectomy Inflammatory factor

First-authors address： The First Peoples Hospital of Jiujiang， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2021.30.002

肺癌是發病率最高的一种恶性肿瘤，其中最常见的就是非小细胞肺癌（NSCLC），占肺癌总数的80%左右，主要包括大细胞癌、腺癌和鳞癌三种，早期症状不明显，严重威胁患者的生命安全[1]。外科手术是治疗NSCLC的主要方法，常规开胸肺叶切除术可以控制患者的病情发展，延长其生存周期，但此手术切口大，患者恢复慢，且疼痛明显[2]。腔镜治疗因具有出血少、创伤小、患者恢复快、切口美观、风险小的优势在临床中广泛应用，腔镜手术治疗可以将开胸手术的视野清晰的展示在术者面前，更符合视觉习惯，使得操作更加安全和精细，降低了手术治疗的难度[3]。癌症本身就会对患者的免疫功能造成影响，手术创伤会加速免疫功能的下降，手术或并发症等可能会加速肿瘤的复发、转移，因此选择对机体影响小的手术方法能更大程度的加速患者康复[4]。本文主……