【摘要】：目的:通過對行胸腔鏡肺葉切除和亞肺葉切除術(shù)患者術(shù)后隨訪及數(shù)據(jù)分析,總結(jié)歸納行兩種術(shù)式患者的臨床數(shù)據(jù)特點(diǎn),探討胸腔鏡亞肺葉切除術(shù)在治療肺部疾病的可行性、安全性及手術(shù)適應(yīng)證,為亞肺葉切除的下一步發(fā)展提供必要的理論依據(jù)和科學(xué)的實(shí)驗(yàn)數(shù)據(jù)。方法:篩選2015年6月至2016年6月我院胸外科診治的行胸腔鏡亞肺葉切除手術(shù)及胸腔鏡肺葉切除手術(shù)120例,根據(jù)手術(shù)方式的不同將所選患者分為肺葉切除術(shù)組68例和亞肺葉切除術(shù)組52例。所選120例患者均行常規(guī)術(shù)前檢查,入院第二天抽取空腹靜脈血查血、生化全項(xiàng)、血凝全項(xiàng)、動(dòng)脈血?dú)庖约澳[瘤標(biāo)志物,查尿、大便常規(guī)、查支氣管鏡、肺部CT、全身ECT及全身PET-CT、測定肺功能,明確診斷疾病,完善術(shù)前準(zhǔn)備,制定手術(shù)計(jì)劃,擇期手術(shù)。兩組患者在性別、吸煙史、術(shù)前肺功能指標(biāo)FEV1、FEV1%、FVC、MVV%及血?dú)夥治鲋笜?biāo)Pa O2、Pa CO2無統(tǒng)計(jì)學(xué)差異,有可比性。比較兩組患者圍手術(shù)期、術(shù)后10天、3個(gè)月的肺功能變化,觀察指標(biāo)包括FEV1%、FVC%、MVV%、Pa O2、Pa CO2。結(jié)果:比較兩組年齡、性別、吸煙史、既往病史、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后住院時(shí)間、術(shù)后閉式引流時(shí)間以及手術(shù)相關(guān)并發(fā)癥發(fā)生情況,結(jié)果顯示兩組患者在年齡、術(shù)后閉式引流時(shí)間48h、術(shù)后住院時(shí)間、術(shù)后并發(fā)癥(肺不張、左心衰、血胸)等方面存在顯著差異,有統(tǒng)計(jì)學(xué)意義(p0.05)。而在性別、吸煙史、既往病史、手術(shù)時(shí)間、術(shù)中出血量等方面,胸腔鏡肺葉切除術(shù)組與亞肺葉切除術(shù)組兩組患者間無顯著差異,無統(tǒng)計(jì)學(xué)意義。測定兩組患者術(shù)前及術(shù)后10天及3個(gè)月肺功能并比較,結(jié)果顯示兩組患者術(shù)前肺功能指標(biāo)FEV1%、FVC%、MVV%無統(tǒng)計(jì)學(xué)差異(p0.05);兩組患者肺功能FEV1%、FVC%、MVV%術(shù)后均較術(shù)前減小,差異明顯有統(tǒng)計(jì)學(xué)意義(p0.05);且術(shù)后胸腔鏡亞肺葉切除術(shù)組患者FEV1%明顯高于胸腔鏡肺葉切除術(shù)患者,差異顯著有統(tǒng)計(jì)學(xué)意義(p0.05),但兩組患者術(shù)后在FVC%、MVV%上無顯著差異無統(tǒng)計(jì)學(xué)意義(p0.05)。觀察兩組患者術(shù)前及術(shù)后1、3、7天Pa O2、Pa CO2值并比較,結(jié)果顯示兩組患者術(shù)前動(dòng)脈血?dú)夥治鰺o顯著差異無統(tǒng)計(jì)學(xué)意義(p0.05);兩組患者術(shù)后第1天、第3天Pa O2值差異顯著有統(tǒng)計(jì)學(xué)意義(p0.05),而Pa CO2無統(tǒng)計(jì)學(xué)意義(p0.05);兩組患者術(shù)后第7天Pa O2、Pa CO2值差異均不顯著,無統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:與胸腔鏡肺葉切除術(shù)比較,亞肺葉切除術(shù)在肺癌治療上有效性、安全性均較高,亞肺葉切除術(shù)可以取得和肺葉切除術(shù)相當(dāng)?shù)寞熜Ф梢员Ａ舾嗟恼７谓M織,減少術(shù)后并發(fā)癥,術(shù)后生活質(zhì)量明顯改善。
[Abstract]:Objective: to summarize the clinical data of patients undergoing thoracoscopic lobectomy and sublobectomy, and to explore the feasibility of thoracoscopic sublobectomy in the treatment of pulmonary diseases. The safety and indications of operation provide the necessary theoretical basis and scientific experimental data for the further development of sublobectomy. Methods: from June 2015 to June 2016, 120 cases of thoracoscopic sublobectomy and thoracoscopic lobectomy were selected. The patients were divided into lobectomy group (n = 68) and sublobectomy group (n = 52). All 120 patients underwent routine preoperative examination. Fasting venous blood samples were collected on the second day of admission for examination of blood, biochemistry, blood coagulation, arterial blood gas and tumor markers, routine examination of urine, stool, bronchoscopy and pulmonary CT,. Systemic ECT and systemic PET-CT, were used to determine lung function, to diagnose disease, to perfect preoperative preparation, to make operation plan, and to select operation. There were no significant differences in sex, smoking history, preoperative pulmonary function index (FEV1,FEV1%,FVC,MVV%) and blood gas analysis index (Pa O _ 2 Pa CO2) between the two groups. The changes of pulmonary function during perioperative period, 10 days and 3 months after operation were compared between the two groups. The observed indexes included FEV1%,FVC%,MVV%,Pa O2Pa CO2.. Results: age, sex, smoking history, medical history, operation time, intraoperative bleeding volume, postoperative hospitalization time, postoperative closed drainage time and operative complications were compared between the two groups. There were significant differences in postoperative closed drainage time, postoperative hospitalization time, postoperative complications (atelectasis, left heart failure, and hemothorax) (p0.05). However, there was no significant difference in sex, smoking history, previous medical history, operative time and intraoperative bleeding volume between the two groups in thoracoscopic lobectomy group and sublobectomy group. Pulmonary function was measured and compared between the two groups before operation and 10 days and 3 months after operation. The results showed that there was no significant difference in preoperative FEV1%,FVC%,MVV% between the two groups (p0.05). The pulmonary function of the two groups decreased after FEV1%,FVC%,MVV% compared with the preoperative, the difference was statistically significant (p0. 05). The FEV1% of patients after thoracoscopic sublobectomy was significantly higher than that of patients with thoracoscopic lobectomy (p0.05), but the difference between the two groups was significant (p0.05). There was no significant difference on MVV% (p0. 05). The CO2 values of Pa O _ 2 Pa were observed and compared between the two groups before operation and 1: 3 days after operation. The results showed that there was no significant difference between the two groups in preoperative arterial blood gas analysis (p0.05). There were significant differences in Pa O 2 values between the two groups on the first day and the third day after operation (p0.05), but Pa CO2 had no statistical significance (p0.05). There was no significant difference in Pa O _ 2 Pa CO2 between the two groups on the 7th day after operation (p0.05). Conclusion: compared with thoracoscopic lobectomy, sublobectomy is effective and safe in the treatment of lung cancer. Sublobectomy can achieve the same curative effect as lobectomy and retain more normal lung tissue. The postoperative complications were reduced and the quality of life was improved significantly.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R655.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 徐晨遠(yuǎn);張旭峰;王征;;肺葉切除手術(shù)不同微創(chuàng)方案的療效對比[J];安徽醫(yī)藥;2015年05期

2 董淑敏;邵仲凡;潘引鵬;戴建華;陳光輝;孫海軍;吳碩明;;全胸腔鏡下肺楔形切除術(shù)治療肺部疾病的臨床分析[J];中華腔鏡外科雜志(電子版);2015年01期

3 陳宇;于在誠;;影響肺癌術(shù)后肺功能恢復(fù)的相關(guān)因素分析[J];臨床肺科雜志;2014年12期

4 劉永靖;于奇;繆軍;陶宇;彭磊磊;戚勝波;呂本博;;單操作孔全胸腔鏡肺葉切除術(shù)的臨床應(yīng)用[J];臨床肺科雜志;2014年10期

5 趙文鵬;朱開梅;;胸腔鏡下肺癌根治術(shù)治療老年非小細(xì)胞肺癌的療效及術(shù)后生存分析[J];中國老年學(xué)雜志;2013年24期

6 李迎新;蔡海波;;胸腔鏡肺葉切除術(shù)術(shù)后早期肺功能變化[J];濟(jì)寧醫(yī)學(xué)院學(xué)報(bào);2013年06期

7 吳秀華;;胸腔鏡肺葉切除術(shù)治療非小細(xì)胞肺癌的臨床觀察[J];中國醫(yī)藥指南;2013年20期

8 魏學(xué)強(qiáng);王平;彭浩;彭俊;許哲源;;不同手術(shù)路徑肺葉切除對早期肺功能的影響[J];重慶醫(yī)學(xué);2013年12期

9 吳衛(wèi)兵;陳亮;朱全;張石江;邵永豐;;直線切割縫合器引導(dǎo)管在全胸腔鏡肺葉、肺段切除中的應(yīng)用[J];中國胸心血管外科臨床雜志;2012年06期

10 張雪飛;史小男;韓彪;;胸腔鏡與開胸肺葉切除術(shù)治療非小細(xì)胞肺癌近期療效的系統(tǒng)評價(jià)[J];中國肺癌雜志;2012年07期

，

本文編號：2368815