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目的:观察胸腔镜肺叶切除术和保留前锯肌的小切口开胸手术治疗早期非小细胞肺癌的效果,检测两种手术后患者的急性期反应,比较两种手术患者机体的创伤情况大小。方法:选取天津医科大学附属肿瘤医院肺部肿瘤科临床诊断为I期和部分II期的非小细胞肺癌患者,分为胸腔镜手术组和小切口开胸手术组,比较两种手术患者的围手术期临床效果,并检测患者血清中CRP、TNF-α、IL-6和IL-10的含量,以辅助判断机体的急性期反应程度,比较两种手术对机体的创伤情况。结果:从2005年7月至2007年1月,共有65位患者入组,其中行胸腔镜根治性肺叶切除术30例,保留前锯肌的小切口开胸手术35例,两种手术患者的带管时间、手术时间、术中失血量、术后引流量等无明显差别;胸腔镜手术可以做到系统性淋巴结清扫。和保留前锯肌的小切口开胸手术相比,胸腔镜手术患者术后疼痛较轻,止痛药服用时间短。胸腔镜手术后1天血清CRP、TNF-α、IL-10的含量均低于小切口开胸手术(48.84±16.89vs65.28±19.80;67.54±18.43vs81.38±21.72;55.49±9.87vs74.28±14.97)。结论:胸腔镜肺叶切除术可以做到系统性淋巴结清扫,与小切口的开胸手术相比,胸腔镜肺叶切除术后患者的急性期反应低、对机体的创伤小,胸腔镜肺叶切除术在治疗早期非小细胞肺癌中可能优于保留前锯肌的小切口开胸肺叶切除术。
OBJECTIVE: To observe the effect of thoracoscopic lobectomy and mini-incision and thoracotomy for preservation of anterior serratus in the treatment of early stage non-small cell lung cancer (NSCLC). The acute phase responses of the two surgical patients were measured and the trauma of the two surgical patients was compared. Methods: The patients with non-small cell lung cancer who were diagnosed as stage I and part II in the Department of Lung Oncology, Affiliated Tumor Hospital Affiliated to Tianjin Medical University were selected and divided into thoracoscopic surgery group and small incision thoracotomy group. The clinical effect of the operation and the levels of CRP, TNF-α, IL-6 and IL-10 in the serum of the patients were examined to help determine the degree of acute phase reaction and to compare the trauma of the two kinds of surgery to the body. Results: From July 2005 to January 2007, a total of 65 patients were enrolled, of whom 30 underwent thoracoscopic radical lobectomy and 35 underwent small incision and thoracotomy for anterior serratus. There was no significant difference in the time of tube insertion, operation time, intraoperative blood loss, postoperative drainage and so on. Thoracoscopic surgery could achieve systematic lymph node dissection. Compared with the small incision thoracotomy, which preserves the anterior serratus muscle, postoperative thoracoscopic surgery patients have less postoperative pain and the analgesics take less time. The contents of serum CRP, TNF-α and IL-10 in one day after thoracoscopic surgery were lower than those of small incision thoracotomy (48.84 ± 16.89vs65.28 ± 19.80; 67.54 ± 18.43vs81.38 ± 21.72; 55.49 ± 9.87vs74. 28 ± 14.97). Conclusions: Thoracostomy and lobectomy can achieve systematic lymphadenectomy. Compared with the small incision thoracotomy, the acute phase response after thoracoscopic lobectomy is low, and the trauma to the body is small. Thoracoscopic lobectomy The treatment of early non-small cell lung cancer may be superior to retain the serratus anterior small lobectomy lobectomy.