本文選題：電視胸腔鏡 + 電視胸腔鏡肺葉切除術(shù)�。� 參考：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的比較探討電視胸腔鏡手術(shù)(video assist thoracoscopic surgery, VATS)和傳統(tǒng)開胸肺癌根治術(shù)治療原發(fā)性非小細(xì)胞癌(non-small cell lung cancer, NSCLC)的臨床應(yīng)用價值。方法選取2013年1月～2014年6月入我院胸外科住院手術(shù)治療的早期原發(fā)性非小細(xì)胞癌患者80例,術(shù)前開展胸部CT、CT引導(dǎo)下穿刺或支氣管鏡檢等檢查,均經(jīng)臨床初步診斷為早期周圍型肺癌,將其分為電視胸腔鏡手術(shù)組(觀察組,n=42例)和傳統(tǒng)開胸肺癌根治術(shù)組(對照組,n=38例),兩組患者均接受肺葉切除術(shù)及系統(tǒng)性淋巴結(jié)清掃術(shù)治療,比較兩組患者圍手術(shù)期指標(biāo)、相關(guān)實驗室指標(biāo)與生活質(zhì)量改變情況。結(jié)果兩組患者的年齡、性別、合并基礎(chǔ)疾病、腫瘤部位及其直徑、病理類型及術(shù)后病理分期等資料比較差異均無統(tǒng)計學(xué)意義(P0.05)。兩組患者的手術(shù)時間、術(shù)后白細(xì)胞、血清前白蛋白和住院費(fèi)用比較差異無統(tǒng)計學(xué)意義(P0.05)。觀察組患者的術(shù)中出血量少于對照組,術(shù)后引流量少于對照組,術(shù)后首次下床時間和術(shù)后住院時間均短于對照組,組間比較差異均有統(tǒng)計學(xué)意義(P0.05)。兩組患者在淋巴結(jié)清掃數(shù)目、轉(zhuǎn)移淋巴結(jié)數(shù)目、術(shù)后復(fù)發(fā)與轉(zhuǎn)移方面比較差異無統(tǒng)計學(xué)意義(P0.05)術(shù)前兩組患者超敏C-反應(yīng)蛋白水平(high-sensitivity C-reactiveprotein, hs-CRP)比較差異無統(tǒng)計學(xué)意義(P0.05),術(shù)后兩組患者超敏C反應(yīng)蛋白(hs-CRP)均較術(shù)前升高(P0.05),其中觀察組hs-CRP水平明顯低于對照組,組間比較差異有統(tǒng)計學(xué)意義(p0.05)。兩組患者術(shù)前肺活量(vital capacity, VC)、第一秒用力呼氣量(forced expiratory volume in 1 second,FEV1)、最大通氣量(maximal voluntary ventilation, MVV)三項指標(biāo)比較均無明顯差異(P0.05),術(shù)后1個月和3個月兩組患者上述指標(biāo)比較差異均有統(tǒng)計學(xué)意義(P0.05)。兩組患者術(shù)前生活質(zhì)量比較差異無統(tǒng)計學(xué)意義(P0.05),術(shù)后均較術(shù)前明顯提高,兩組術(shù)后比較差異均有統(tǒng)計學(xué)意義(P0.05)。觀察組患者的生理狀況和功能狀況評分均明顯高于對照組,比較差異均有統(tǒng)計學(xué)意義(P0.05)。結(jié)論電視胸腔鏡肺葉切除術(shù)與傳統(tǒng)開胸手術(shù)在淋巴結(jié)清掃、術(shù)后復(fù)發(fā)與轉(zhuǎn)移等方面的近期療效相當(dāng)。但與后者相比,電視胸腔鏡肺葉切除術(shù)具有微創(chuàng)、術(shù)后肺功能損害小、恢復(fù)快、術(shù)后住院時間短、患者早中期生活質(zhì)量高等優(yōu)點,可作為一種治療早期非小細(xì)胞肺癌的常規(guī)手段,具有臨床推廣應(yīng)用價值。
[Abstract]:Objective to evaluate the clinical value of video-assisted thoracoscopic surgery (video assist thoracoscopic surgery, vats) and conventional radical thoracotomy for primary non-small cell carcinoma (non-small cell lung cancer, NSCLC). Methods from January 2013 to June 2014, 80 patients with early primary non-small cell carcinoma (NSCC) admitted to our hospital from January 2013 to June 2014 were examined by CT guided puncture or bronchoscopy. All patients were clinically diagnosed as early peripheral lung cancer. The patients were divided into two groups: video-assisted thoracoscopic surgery group (n = 42) and conventional thoracotomy group (n = 38). The patients in both groups were treated with lobectomy and systemic lymph node dissection. The perioperative indexes were compared between the two groups. Changes in laboratory indicators and quality of life. Results there was no significant difference in age, sex, underlying diseases, tumor location and diameter, pathological types and postoperative pathological stages between the two groups (P0.05). There was no significant difference in operation time, white blood cell, serum prealbumin and hospitalization cost between the two groups (P0.05). The amount of intraoperative bleeding in the observation group was less than that in the control group, the postoperative drainage volume was less than that in the control group, the first time of getting out of bed and the time of hospitalization after operation were shorter than those in the control group, and the differences between the two groups were statistically significant (P0.05). The number of lymph node dissection and metastatic lymph nodes in both groups, There was no significant difference in postoperative recurrence and metastasis (P0.05). There was no significant difference in high-sensitivity C-reactive protein (hs-CRP) between the two groups before operation (P0.05). The level of hs-CRP in the observation group was significantly lower than that in the control group. The difference between the two groups was statistically significant (p 0.05). There were no significant differences among the three indexes of vital capacity (vital capacity, VC), forced expiratory volume (forced expiratory volume in 1 second FEV1) and maximal ventilation volume (maximal voluntary ventilation, MV) in the two groups before operation (P0.05), but there were significant differences between the two groups at 1 month and 3 months after operation (P0.05). There was no significant difference in the quality of life between the two groups before operation (P0.05), and there was significant difference between the two groups after operation (P0.05). The scores of physiological and functional status in the observation group were significantly higher than those in the control group, and the differences were statistically significant (P0.05). Conclusion Video-assisted thoracoscopic lobectomy and traditional thoracotomy are effective in lymph node dissection, recurrence and metastasis. But compared with the latter, video-assisted thoracoscopic lobectomy has the advantages of minimally invasive, small postoperative lung function damage, rapid recovery, short postoperative hospital stay and high quality of life. It can be used as a routine therapy for early non-small cell lung cancer.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R734.2

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