«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2025年01期

页码:

62-67

栏目:

论著

出版日期:

2025-02-25

文章信息/Info

Title:

Clinical application of Flex-3D thoracoscopic lobectomy in non-small cell lung cancer

作者:

杨柯佳; 孙 琦; 瞿伟丰; 翁 鸢; 崔启辰; 李金友

214000 无锡,江南大学附属医院胸心外科

Author(s):

Yang Kejia;  Sun Qi;  Qu Weifeng;  Weng Yuan;  Cui Qichen;  Li Jinyou.

Department of Thoracic and Cardiovascular Surgery, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000

关键词:

非小细胞肺癌;  肺叶切除术;  Flex-3D胸腔镜;  2D胸腔镜;  临床应用

Keywords:

Non-small cell lung cancer;  Lobectomy;  Flex-3D thoracoscopy;  2D thoracoscopy;  Clinical application

分类号:

R734.2

DOI:

10.3877/cma.j.issn.1674-6902.2025.01.010

摘要:

目的 分析Flex-3D胸腔镜肺叶切除术在非小细胞肺癌(non-small cell lung cancer, NSCLC)中的临床应用。方法 选择2021年6月至2023年8月我院收治的147例NSCLC患者为对象,接受Flex-3D胸腔镜肺叶切除术78例为观察组、接受传统2D胸腔镜肺叶切除术69例为对照组。术后随访半年。记录两组手术时间、术后拔管时间、术后住院时间、淋巴结清扫、手术应激检测指标,前列腺素E₂(prostaglandin E₂, PGE₂)、P物质(substance P, SP)、热休克蛋白70(heat shock protein 70,HSP70)、动脉血氧分压(partial pressure of oxygen in arterial blood, PaO₂)、动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial blood, PaCO₂)、肺功能指标膈肌活动度、用力肺活量(forced vital capacity,FVC)、1秒用力呼气容积(forced expiratory volume in 1 second, FEV₁)、术后并发症及复发、转移情况。结果 观察组手术时间(166.26±38.57)min、,术后拔管时间(5.64±1.28)d,术后住院时间(7.37±1.66)d,淋巴结清扫数(13.25±3.01)枚; 对照组手术时间(182.38±33.05)min,术后拔管时间(6.73±1.56)d,术后住院时间(8.22±1.05)d,淋巴结清扫数(11.89±1.77)枚(P<0.05)。术后第2天,观察组PGE₂(123.06±21.52)pg/ml、SP(5.33±1.74)μg/ml、HSP 70(31.03±6.25 )ng/ml低于对照组PGE₂(131.74±22.38 )pg/ml、SP(6.28±2.09)μg/ml、HSP 70(33.28±6.34 )ng/ml(P<0.05); 术后第1 天、术后第5天,观察组PaO₂高于对照组,PaCO₂低于对照组(P<0.05); 两组术后3个月、6个月FVC、FEV₁及膈肌活动度差异无统计学意义(P>0.05); 两组术后并发症差异无统计学意义(P>0.05); 两组术后半年内未出现远处转移和死亡病例,术后半年观察组肺局部复发3例(3.85%),对照组肺局部复发6例(8.70%)(P=0.306); 观察组纵隔淋巴结转移1例(1.28%),对照组纵隔淋巴结转移1例(1.45%)(P>0.05)。结论 Flex-3D胸腔镜NSCLC肺叶切除术缩短手术时间、提高淋巴结清扫、安全性与传统2D胸腔镜肺叶切除术相同,减轻术中组织损伤。

Abstract:

Objective To explore the clinical effect of Flex-3D thoracoscopic lobectomy in non-small cell lung cancer(NSCLC). Methods The clinical data of 147 patients with NSCLC admitted from June 2021 to August 2023 were retrospectively analyzed. According to the type of thoracoscopy used during surgery, the patients were divided into observation group 78 cases and control group 69 cases. Patients in the observation group received Flex-3D thoracoscopic lobectomy, and patients in the control group received traditional 2D thoracoscopic lobectomy, and were followed up by outpatient follow-up within 6 month after surgery. The data of the two groups were recorded at different time points before and after operation, including indicators of surgical indexes,operation time, postoperative extubation time, postoperative hospitalization time, number of lymph node dissection, surgical stress indexes [prostaglandin E₂(PGE₂), substance P(SP), heat shock protein 70(HSP70)], blood gas indexes [partial pressure of oxygen in arterial blood(PaO₂), partial pressure of carbon dioxide in arterial blood(PaCO₂)], pulmonary function indicators [diaphragm activity, forced vital capacity(FVC), forced expiratory volume in 1 second(FEV₁)], postoperative complications, recurrence and metastasis. Results The operation time of observation group and control group was(166.26±38.57)min and(182.38±33.05)min, and the postoperative extubation time was(5.64±1.28)d and(6.73±1.56)d, respectively. Postoperative hospitalization time was(7.37±1.66)d,(8.22±1.05)d, and the number of lymph nodes were(13.25±3.01)and(11.89±1.77), respectively, with statistical significance(P<0.05). On the 2nd day after surgery, the levels of PGE₂(123.06±21.52)pg/ml, SP(5.33±1.74)μg/ml and HSP70(31.03±6.25 )ng/ml in the observation group were lower than those in the control group(131.74±22.38 )pg/ml,(6.28±2.09)μg/ml,(33.28±6.34 )ng/ml(P<0.05); On the 1st and 5th day after surgery, the PaO₂ level in the observation group was higher than that in the control group, and the PaCO₂ level was lower than that in the control group(P<0.05). There were no significant differences in FVC, FEV₁ levels and diaphragmatic activity between the two groups at 3 and 6 months after surgery(P>0.05). Postoperative complications of the patients included pneumonia, pulmonary embolism, atelectasis, subcutaneous emphysema, arrhythmia, chylothorax. There was no statistical significance in the occurrence of complications between the two groups(P>0.05). No distant metastasis or death occurred in patients 6 month after surgery, Local recurrence occurred in 3 cases(3.85%)in the observation group and 6 cases(8.70%)in the control group halfa after operation(P=0.306). One case of mediastinal lymph node metastasis in the observation group(1.28%)and one case of mediastinal lymph node metastasis in the control group(1.45%)(P>0.05). Conclusion Flex-3D thoracoscopic lobectomy has a good application effect in NSCLC patients, which is conducive to shortening the operation time, improving the efficacy of lymph node dissection, and reducing intraoperative injury, and the safety is comparable to that of traditional 2D thoracoscopic lobectomy.

参考文献/References:

1 Cao W, Chen HD, Yu YW, et al. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020[J]. Chin Med J(Engl), 2021, 134(7): 783-791.
2 王贵刚, 董跃华, 魏玉磊, 等. 三维CT支气管血管成像联合3D打印技术在早期肺癌患者胸腔镜肺段切除术中的应用价值[J]. 中国医学计算机成像杂志, 2024, 30(5): 544-548.
3 孙大强, 陈平雁, 刘伦旭, 等. 11958例Ⅰ～ⅢA期非小细胞肺癌手术患者不同随访方式5年生存率比较的多中心真实世界研究[J]. 中国胸心血管外科临床杂志, 2021, 28(6): 615-622.
4 Li X, Cui F, Xing T, et al. Glasses-free 3D versus 2D video-assisted thoracoscopic thymectomy: a single-center short-term comparative study[J]. Ann Transl Med, 2019, 7(23): 761.
5 中华医学会, 中华医学会肿瘤学分会, 中华医学会杂志社. 中华医学会肺癌临床诊疗指南(2018版)[J]. 中华肿瘤杂志, 2018, 40(12): 935-964.
6 金 莉, 周彩存. 肺癌围手术期免疫治疗的进展、争议与共识[J]. 中国肿瘤临床, 2024, 51(16): 817-821.
7 胡雪艳, 孟凡亮, 董娟娟. 不同病理分型的初治非小细胞肺癌骨转移患者的预后分析[J]. 实用医学杂志, 2024, 40(16): 2316-2325.
8 茅怡铭, 陆文强, 戴春雷. 老年患者3D单孔胸腔镜单向式解剖性右肺上叶切除术的学习曲线[J]. 老年医学与保健, 2024, 30(4): 1003-1007+1013.
9 姚灵琦, 常啸岩, 沈志平, 等. 全孔机器人与胸腔镜在ⅠA期非小细胞肺癌肺叶切除术中疗效比较的回顾性队列研究[J]. 中国胸心血管外科临床杂志, 2023, 30(10): 1390-1395.
10 Yun JK, Park I, Kim HR, et al. Long-term outcomes of video-assisted thoracoscopic lobectomy for clinical N1 non-small cell lung cancer: A propensity score-weighted comparison with open thoracotomy[J]. Lung Cancer, 2020, 150: 201-208.
11 刘会宁, 彭 军, 任迎春, 等. 34例胸腔镜下肺楔形切除与21例肺段切除对位于肺段P区的ⅠA1期非小细胞肺癌治疗比较[J]. 山东大学学报(医学版), 2022, 60(11): 38-43.
12 武 强, 孔 浩, 张博友, 等. 早期非小细胞肺癌外科手术方式的争议[J]. 中国胸心血管外科临床杂志, 2022, 29(8): 1066-1072.
13 胡 航, 陈婷婷, 孙 健, 等.三维重建技术在单操作孔胸腔镜肺段切除术的临床应用[J/CD]. 中华肺部疾病杂志(电子版),2024, 17(2): 310-312.
14 王小卫, 濮忠建, 包军军, 等. 单孔、两孔及三孔胸腔镜下肺叶切除术对老年早期非小细胞肺癌的临床疗效及对氧化应激的影响[J]. 中国医药导报, 2024, 21(2): 124-127+131.
15 张欣宇, 李林倩, 李浩然, 等. 计算机辅助设计修饰3D打印模型用于早期肺癌胸腔镜亚肺叶切除术的回顾性队列研究[J]. 中国胸心血管外科临床杂志, 2024, 31(9): 1266-1273.
16 Patel AJ, Bille A. Lymph node dissection in lung cancer surgery[J]. Front Surg, 2024, 11: 1389943.
17 Um J, Jung N, Chin S, et al. Substance P enhances EPC mobilization for accelerated wound healing[J]. Wound Repair Regen, 2016, 24(2): 402-410.
18 王丰松, 曾琴琴, 高 山, 等. 肺癌早期患者术后心理应激现状及应激相关因子HSP70、IFN-γ关联性[J]. 中国老年学杂志, 2019, 39(8): 1839-1842.
19 李朝平, 王光军. Flex-3D胸腔镜、2D胸腔镜肺叶切除术治疗原发性肺癌疗效对比[J]. 中国临床医生杂志, 2021, 49(10): 1203-1206.
20 洪子强, 苟文曦, 逯英杰, 等. 达芬奇机器人手术与胸腔镜手术治疗非小细胞肺癌的短期疗效及成本分析[J]. 中国胸心血管外科临床杂志, 2024, 31(7): 974-979.
21 杨高兰, 高晓琴, 黄云萍, 等. 三球仪呼吸功能训练在老年非小细胞肺癌胸腔镜下肺叶切除术患者中的应用[J]. 中国老年学杂志, 2024, 44(22): 5434-5437.
22 贾春祎, 邹勤光, 赵 晖, 等. 胸腔镜下亚肺叶切除与肺叶切除治疗ⅠA期非小细胞肺癌的临床疗效[J]. 中国老年学杂志, 2023, 43(23): 5686-5689.
23 金宽哲, 黄燕飞, 吴小波. 吸入式异丙托溴铵治疗非小细胞肺癌合并慢性阻塞性肺疾病患者的临床研究[J]. 中国临床药理学杂志, 2024, 40(6): 802-806.
24 余俊杰, 陈宝钧, 程 晶, 等. 胸腔镜下肺段或肺叶切除术对老年非小细胞肺癌患者肺功能及血气指标的影响[J]. 中国老年学杂志, 2024, 44(14): 3362-3366.
25 Seong YW, Jeon JH, Jang HJ, et al. Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy[J]. J Cardiothorac Surg, 2021, 16(1): 302.
26 王长兴, 成 刚, 佘晓伟, 等. 胸腔镜肺癌精准切除策略的肿瘤学疗效、肺功能、复发率及安全性研究[J]. 疑难病杂志, 2022, 21(12): 1259-1263+1270.
27 黄可南, 丁新宇, 陈子豪, 等. 3D胸腔镜与2D胸腔镜在单孔肺叶切除术中的临床对比研究[J]. 中国胸心血管外科临床杂志, 2020, 27(7): 770-774.
28 白雪莹, 刘正华. 3D与2D单孔胸腔镜肺叶切除术的疗效比较[J]. 中国医科大学学报, 2023, 52(3): 277-281.
29 梁建伟, 曹 兵, 王 晨, 等. 传统2D胸腔镜和Flex-3D胸腔镜在非小细胞肺癌患者肺叶切除术中的应用效果研究[J]. 实用心脑肺血管病杂志, 2024, 32(2): 34-38.
30 袁 伟, 刘 娜, 王宇琛. Flex-3D胸腔镜与2D胸腔镜肺叶切除术治疗原发性肺癌的效果及预后[J]. 中国临床研究, 2020, 33(4): 461-464.

备注/Memo

备注/Memo:

通信作者: 李金友, Email: 9862019005@jiangnan.edu.cn

常用功能

更新日期/Last Update: 2025-02-20