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高海拔地区老年非小细胞肺癌患者接受全电视胸腔镜下肺叶切除的安全性和预后分析
         
Effect of high-altitude exposure on safety of complete video-assisted thoracoscopic surgery lobectomy in elderly patients with non-small cell lung cancer and analysis of prognosis

摘    要
目的:探讨全电视辅助胸腔镜(complete video-assisted thoracoscopic surgery,c-VATS)肺叶切除术治疗高海拔地区老年(>60岁)非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的安全性和预后。 方法:研究对象为2010年1月1日-12月31日本科收治的49例接受c-VATS肺叶切除术的高海拔地区老年(>60岁)NSCLC患者(c-VATS组),并且按照临床分期和术后病理类型选择配对的49例接受常规开胸肺叶切除术的高海拔地区老年NSCLC患者作为对照(常规开胸手术组)。观察和比较两组患者的手术时间、术中失血量、术后胸管放置时间、胸液引流量、拆线时间、住院天数、切口疼痛评分和围手术期并发症发生率;检测和比较两组患者手术前和手术后6个月时的肺功能和动脉血气。对所有患者进行随访,计算并比较两组患者的1和2年生存率。 结果:c-VATS组患者的手术时间较常规开胸手术组明显延长(P<0.01),而术中失血量、术后胸管放置时间、胸液引流量、拆线时间、住院天数和切口疼痛评分均较常规开胸手术组明显缩短或减少(P<0.01)。c-VATS组患者术后肺活量、用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积/用力肺活量比值、用力呼出25%和50%肺活量时的呼气流量以及每分钟最大通气量较术前的降低程度明显小于常规开胸手术组(P<0.05),术后动脉血氧分压和动脉血氧饱和度较术前的提高程度以及动脉血二氧化碳分压较术前的降低程度均明显大于常规开胸手术组(P<0.05)。c-VATS组围手术期并发症发生率为4.08%,常规开胸手术组为12.24%,差异有统计学意义(P<0.05)。c-VATS组Ⅰ、Ⅱ和ⅢA期患者术后1年和2年生存率与常规开胸手术组比较,差异均无统计学意义(P>0.05)。 结论:c-VATS肺叶切除术与传统开胸肺叶切除术相比,创伤小、出血少、肺功能减损程度轻、并发症少、恢复快,值得在高海拔地区进行临床推广。
标    签   非小细胞肺   老年人   高海拔   电视辅助胸腔镜手术   肺叶切除术   常规开胸手术   手术中并发症   存活率分析   Carcinoma   non-small cell lung   Aged   High altitude   Video-assisted thoracoscopic surgery   Lung lobectomy   Conventional open thoracotomy   Intraoperative complications   Survival analysis  
 
Abstract
Objective:To investigate the effect of high-altitude exposure (above altitude of 2 000 meters) on safety of c-VATS (complete video-assisted thoracoscopic surgery) lobectomy in elderly patients (>60 years) with NSCLC (non-small cell lung cancer) and analysis of prognosis.Methods:Matched casecontrol study was performed to recruit 49 elderly NSCLC patients receiving c-VATS lobectomy and 49 matched (according to clinical staging and histology) elderly NSCLC patients receiving COT (conventional open thoracotomy) lobectomy in high-altitude area between January 1, 2010 and December 31, 2010. The perioperative variables including operative time, intraoperative blood loss, duration of postoperative chest tube placement, postoperative pleural effusion, time to suture removal, length of hospitalization, postoperative incisional pain rating and complication rate were compared between c-VATS lobectomy group and COT lobectomy group. The variables of pulmonary function and arterial blood gas tests before and six months after operation were also compared between the two groups. The follow-up was conducted. The one- and two-year survival rates were calculated and compared between the two groups.Results:The operative time was longer in c-VATS lobectomy group than in COT lobectomy group (P<0.01). The intraoperative blood loss, duration of postoperative chest tube placement, postoperative pleural effusion, time to suture removal, length of postoperative hospitalization and postoperative incisional pain rating were lower in c-VATS lobectomy group than in COT lobectomy group (P<0.01). The percentage decrease of VC (vital capacity), FEV (forced vital capacity), FEV1 (forced expiratory volume in one second), FEV1/FEV ratio, FEF25 (forced expiratory flow at 25% of vital capacity), FEF50 and MVV (maximal voluntary ventilation) six months after operation vs before operation was significantly less in c-VATS lobectomy group than in COT lobectomy group (P<0.05). The percentage increase of PaO2 (arterial partial pressure of oxygen) and PaCO2 (arterial partial pressure of carbon dioxide) and the percentage decrease of PaCO2 (partial pressure of arterial carbon dioxide) six months after operation vs before operation were higher in c-VATS lobectomy group than in COT lobectomy group (P<0.05). The perioperative complication rates in c-VATS lobectomy group and COT lobectomy group were 4.08% and 12.24%, respectively (P<0.05). There were no significant differences in one- and two-year survival rates of stages Ⅰ,Ⅱ and ⅢA patients between c-VATS lobectomy group and COT lobectomy group (P>0.05).Conclusion:Compared with COT lobectomy, elderly NSCLC patients who undergo c-VATS lobectomy may have less trauma, bleeding and damage of pulmonary function, fewer complications, and more rapid recovery. These results reveal a clinical significance of application of c-VATS lobectomy in high-altitude area.

中图分类号 R734.2   DOI 10.3781/j.issn.1000-7431.2013.04.006

 
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所属栏目 临床研究

基金项目 国家自然科学基金资助项目(编号:W2011FAI05)

收稿日期 2012/12/24

修改稿日期 2013/1/28

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引用该论文: GUAN Lin,HONG Wen-juan,HONG Zhi-peng,HUANG Tao. Effect of high-altitude exposure on safety of complete video-assisted thoracoscopic surgery lobectomy in elderly patients with non-small cell lung cancer and analysis of prognosis[J]. Tumor, 2013, 33(4): 327~333
管琳,洪文娟,洪志鹏,黄韬. 高海拔地区老年非小细胞肺癌患者接受全电视胸腔镜下肺叶切除的安全性和预后分析[J]. 肿瘤, 2013, 33(4): 327~333


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