摘要
目的 对比单孔、三孔胸腔镜手术对老年非小细胞肺癌(NSCLC)患者术后肿瘤微转移、应激反应的影响.方法 回顾性选取2020年1月至2023年1月江苏省肿瘤医院收治的老年NSCLC患者90例,参考手术方式不同分为单孔组(n=45)与多孔组(n=45),单孔组予以单孔胸腔镜手术,多孔组予以三孔胸腔镜手术.比较两组患者的围手术期指标(术中出血量、手术时间、术后引流量、术后住院时间、胸管留置时间、淋巴结清扫数目)、肿瘤微转移[基质金属蛋白酶9(MMP-9)、肿瘤坏死因子受体相关蛋白(TRAP)1、钙黏附蛋白E(E-cadherin)、Krüppel样因子(KLF)4]、应激反应[前列素E2(PGE2)、5-羟色胺(5-HT)、去甲肾上腺素(NE)、皮质醇]以及术后并发症发生率.结果 单孔组的术中出血量、术后引流量、住院时间及胸管留置时间分别为(36.61±22.31)mL、(971.82±301.52)mL、(6.49±2.50)d、(4.13±1.56)d,均低于多孔组[(68.18±12.18)mL、(1 289.39±604.57)mL、(8.32±3.71)d、(6.42±3.17)d],差异均有统计学意义(P＜0.05);两组手术时间、淋巴结清扫总数目比较,差异均无统计学意义(P＞0.05).单孔组患者术后 1 周的 MMP-9、TRAP1、E-cadherin、KLF4 水平分别为 0.35±0.03、0.40±0.05、2.89±0.29、2.87±0.29,均明显低于多孔组(0.46±0.09、0.52±0.22、3.16±0.53、3.13±0.34),差异均有统计学意义(P＜0.05).单孔组患者手术次日的 PGE2、5-HT、NE、皮质醇水平分别为(182.87±10.29)pg/mL、(0.68±0.05)μmol/mL、(2.85±0.28)pg/mL、(95.69±10.05)ng/mL,均明显低于多孔组[(198.98±11.79)pg/mL、(0.91±0.14)μmol/mL、(4.71±0.57)pg/mL、(116.88±18.81)ng/mL],差异均有统计学意义(P＜0.05).术后两组患者的微小并发症、重大并发症以及总并发症发生率比较,差异均无统计学意义(P＞0.05).结论 对于老年NSCLC患者,与三孔胸腔镜手术相比,采用单孔胸腔镜术围手术期恢复更快,应激反应更小,肿瘤细胞微转移活跃度更加稳定,具有良好的预后效果.
Abstract
Objective To analyze and compare the effects of single-aperture thoracoscopy and three-aperture thoracoscopy on postoper-ative tumor micrometastasis and stress response in elderly patients with non-small cell lung carcinoma(NSCLC).Methods A total of 90 elderly patients with NSCLC admitted to Jiangsu Cancer Hospital from January 2020 to January 2023 were retrospectively selected.They were divided into the single-aperture group(n=45)and the multi-port group(n=45)according to different surgical methods.The single-aperture group re-ceived single-aperture thoracoscopic surgery,while the multi-port group received three-aperture thoracoscopic surgery.Perioperative indexes(intraoperative blood loss,operative time,postoperative drainage,postoperative hospital stay,chest tube indwelling time,number of lymph node dissection),tumor micrometastasis[matrix metalloproteinase 9(MMP-9),tumor necrosis factor receptor-associated protein(TRAP)1,E-cadherin,Kriippel-like factors(KLF)4],stress response[prostaglandin E2(PGE2),5-hydroxytryptamine(5-HT),noradrenaline(NE),cortisol]and postoperative complications were compared between the two groups.Results The intraoperative blood loss,postoperative drainage volume,hospitalization time and chest tube indwelling time in the single-port group were(36.61±22.31)mL,(971.82±301.52)mL,(6.49±2.50)d and(4.13±1.56)d,respectively,which were lower than those in the multi-port group[(68.18±12.18)mL,(1 289.39±604.57)mL,(8.32±3.71)d and(6.42±3.17)d],and the differences were statistically significant(P＜0.05),while there were no statistically significant differences in the operative time and the total number of lymph nodes dissection between the two groups(P＞0.05).The levels of MMP9,TRAP1,E-cadherin and KLF4 in the single-port group were 0.35±0.03,0.40±0.05,2.89±0.29 and 2.87±0.29,respectively,which were significantly lower than those in the multi-port group(0.46±0.09,0.52±0.22,3.16±0.53,3.13±0.34),and the differences were statistically significant(P＜0.05).The levels of PGE2,5-HT,NE and cortisol in the single-hole group were(182.87±10.29)pg/mL,(0.68±0.05)μmol/mL,(2.85±0.28)pg/mL and(95.69±10.05)ng/mL,respectively,which were significantly lower than those in the porous group[(198.98±11.79)pg/mL,(0.91±0.14)μmol/mL,(4.71±0.57)pg/mL,(116.88±18.81)ng/mL],the differences were statistically significant(P＜0.05).There were no statistically significant differences in the incidence of total complications,minor complications and major complications(P＞0.05).Conclusion For elderly patients with NSCLC,compared with three-hole thoraco-scopic surgery,the perioperative recovery of single-hole thoracoscopic surgery has faster perioperative recovery,smaller stress response,more sta-ble tumor cell micrometastasis activity,and which has better prognosis.
维普
万方数据