广西医学

目的探讨全胸腔镜肺叶切除术中血管离断顺序对非小细胞肺癌（NSCLC）患者疗效及生存情况的影响。方法将59例NSCLC患者随机分为A组(n=29)和B组(n=30)，两组均给予全胸腔镜肺叶切除术，其中A组先离断肺动脉再离断肺静脉，B组先离断肺静脉再离断肺动脉。比较两组手术指标（术中出血量、手术时间、淋巴结清扫数量、术后胸管引流时间及引流量、术后住院时间），手术前后的血清疼痛因子［多巴胺、5-羟色胺、去甲肾上腺素(NE)、白细胞介素 6(IL-6)、肿瘤坏死因子α（TNF-α）］水平、肺功能指标［用力肺活量占预计值百分比(FVC%)、第1秒用力呼气量占预计值百分比(FEV1%)、每分钟最大通气量占预计值百分比(MVV%)］，以及术后的无进展生存时间。结果 A组的术中出血量少于B组(P＜0.05)，两组的手术时间、淋巴结清扫数量、术后胸管引流时间和引流量、术后住院时间差异无统计学意义(P＞0.05)。术后两组的血清多巴胺、5-羟色胺、NE、IL-6、TNF-α水平较术前升高，FEV1%、FVC%、MVV%较术前降低，但两者上述指标差异无统计学意义(P＞0.05)。两组术后的无进展生存时间差异无统计学意义(P＞0.05)。结论全胸腔镜肺叶切除术中先离断肺动脉可减少术中出血量，但血管离断顺序对NSCLC患者术后疼痛、肺功能及生存时间的影响相似，临床上可根据术中情况合理选择血管离断顺序。

ObjectiveTo investigate the efficacy of intraoperative devascularization sequence in total thoracoscopic lobectomy on patients with non small cell lung cancer (NSCLC) and its effect of survival states. MethodsA total of 59 NSCLC patients were randomly divided into group A (n=29) or group B (n=30). Both groups received total thoracoscopic lobectomy, therein pulmonary artery was firstly devascularized, and then pulmonary vein was devascularized in group A, whereas group B received firstly pulmonary vein devascularization, and then pulmonary artery devascularization. Surgical indices (intraoperative bleeding volume, operation duration, number of lymph node dissection, postoperative thoracic catheter drainage time and drainage volume, and postoperative length of hospital stay), pre- and postoperative serum pain factors (dopamine, 5-hydroxytryptamine, norepinephrine ［NE］, interleukin 6 ［IL-6］, and tumor necrosis factor α ［TNF-α］) levels, pulmonary function indices (forced vital capacity as a percentage of the predicted value ［FVC%］, forced expiratory volume in one second as a percentage of the predicted value ［FEV1%］, maximum ventilatory volume as a percentage of the predicted value ［MVV%］), as well as postoperative progression-free survival time were compared between the two groups. ResultsThe intraoperative bleeding volume of group A was less than that of group B (P＜0.05), and there was no statistically significant difference in operation duration, number of lymph node dissection, postoperative thoracic catheter drainage time and drainage volume, postoperative length of hospital stay between the two groups (P＞0.05). Postoperative serum dopamine, 5-hydroxytryptamine, NE, IL-6, TNF-α levels of the two groups were elevated, and FEV1%, FVC%, MVV% were decreased as compared with before operation, but there was no statistically significant difference in the aforementioned indices between the two groups (P＞0.05). There was no statistically significant difference in progression-free survival time between the two groups (P＞0.05). ConclusionFirst devascularization of pulmonary artery in total thoracoscopic lobectomy can reduce intraoperative bleeding volume, but the effect of devascularization sequence on postoperative pain, pulmonary function, and survival time is similar in NSCLC patients. Selection of devascularization sequence can be reasonably conducted according to intraoperative conditions in clinics.