单孔胸腔镜下肺亚段/肺段切除术在老年肺结节患者中的临床应用

Clinical application of uniportal VATS thoracoscopic subsegment/segmentectomy in elderly patients with pulmonary nodules

摘要:

目的 比较老年肺结节患者单孔胸腔镜下行肺亚段与肺段切除的临床疗效。方法 回顾性分析2021年2月—2022年1月胜利油田中心医院收治的103例老年肺结节患者的临床资料，根据手术方式分为肺亚段切除组（52例）、肺段切除组（51例）。比较两组术中和术后恢复情况、围手术期应激反应、肺功能、生活质量、围手术期并发症，并统计两组肿瘤复发转移情况。结果 两组术中出血量、淋巴结采样数、标本切缘距离、术后拔管时间、术后住院时间比较，差异均无统计学意义（P >0.05）。肺亚段切除组的切除亚段数、术后胸腔引流量低于肺段切除组（P <0.05），肺亚段切除组的手术时间长于肺段切除组（P <0.05）。肺亚段切除组术前和术后24 h的皮质醇、丙二醛、活性氧簇的差值低于肺段切除组（P <0.05）。肺亚段切除组治疗前后的用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）/FVC的差值高于肺段切除组（P <0.05）。肺亚段切除组治疗前后的肺癌患者生存质量评定量表（FACT-L）评分的差值高于肺段切除组（P <0.05）。两组并发症发生率比较，差异无统计学意义（P >0.05）。两组随访期间均无复发转移。结论 与肺段切除术相比，单孔胸腔镜下肺亚段切除老年肺结节可更大程度地保留患者肺功能，减少术后胸腔引流量，减轻围手术期应激反应，提高患者术后生活质量，但肿瘤学疗效仍需随访数据进一步完善。

Abstract:

Objective To compare the clinical efficacy of uniportal video-assisted thoracoscopic sublobar resection versus segmental resection in elderly patients with pulmonary nodules.Methods A retrospective analysis was conducted on the clinical data of 103 elderly patients with pulmonary nodules treated at Shengli Oilfield Central Hospital from February 2021 to January 2022. Patients were divided into the sublobar resection group (52 patients) and the segmental resection group (51 patients). We compared intraoperative and postoperative recovery, perioperative stress response, pulmonary function, quality of life, perioperative complications, and tumor recurrence and metastasis between the two groups.Results There were no significant differences in intraoperative blood loss, number of lymph nodes sampled, specimen margin distance, postoperative tube removal time, and postoperative hospital stay between the two groups (P >0.05). The number of subsegments resected and postoperative chest drainage volume were lower in the sublobar resection group (P <0.05), whereas the operation time was longer than in the segmental resection group (P <0.05). Differences in preoperative and 24-hour postoperative levels of cortisol, malondialdehyde, and reactive oxygen species were lower in the sublobar resection group (P <0.05). The differences in forced vital capacity (FVC) and the ratio of forced expiratory volume in one second to FVC (FEV₁/FVC) before and after treatment were higher in the sublobar resection group (P <0.05). Changes in the Functional Assessment of Cancer Therapy-Lung (FACT-L) scores before and after treatment were also higher in the sublobar resection group (P <0.05). The incidence of complications was comparable between the groups (P >0.05), and there were no cases of recurrence or metastasis during the follow-up period.Conclusion Compared to segmental resection, uniportal video-assisted thoracoscopic sublobar resection in elderly patients with pulmonary nodules can better preserve lung function, reduce postoperative chest drainage, mitigate perioperative stress responses, and improve postoperative quality of life. However, the oncological efficacy needs further validation through follow-up data.