胸腔镜与开胸根治术治疗肺大细胞癌疗效比较及对血清NSE、CA125和EGF水平的影响

摘要

目的:比较胸腔镜与开胸根治术治疗肺大细胞癌疗效及对患者血清神经元特异性烯醇化酶(neuron specific enolase,NSE)、癌抗原125(cancer antigen 125,CA125)和表皮生长因子(epidermal growth factor,EGF)水平的影响.方法:收集我院133例肺大细胞癌的临床资料,按照手术方式不同分为胸腔镜组76例与开胸组57例.观察并比较两组患者手术状况、手术疗效、并发症发生状况及血清NSE、CA125和EGF水平.结果:胸腔镜组患者无中转开腹手术病例.胸腔镜组手术时间、术中出血量、术后引流管放置时间、术后第5天视觉模拟评分(visual analogue scale,VAS)及住院时间显著少于开胸组,胸腔镜组住院费用显著多于开胸组患者,差异均具有统计学意义(P均<0.05).开胸组患者与胸腔镜组病灶均完整切除,切缘阴性,淋巴结清扫组数、清扫个数、淋巴结阳性率及术后2年生存率均无显著统计学差异(P均>0.05).术后,胸腔镜组并发症总发生率显著低于开胸组患者(P<0.05).术后第7天,开胸组与胸腔镜组患者NSE、CA125和EGF水平均有所下降(P均<0.05),胸腔镜组患者术后第7天的EGF水平显著低于开胸组患者(P<0.05),而NSE、CA125水平组间比较无统计学差异(P均>0.05).结论:胸腔镜与开胸根治术均是肺大细胞癌的有效手术方式,手术疗效无明显差异.与开胸手术相比,胸腔镜手术创伤小,术后并发症发生率低,有利于术后恢复,并且能够降低血清EGF水平,对于适合胸腔镜根治术的肺大细胞癌患者宜选择该手术方式.%Objective:To compare efficacy between thoracoscopic surgery and thoracotomy and investigate their effects on serum levels of neuron specific enolase(NSE),cancer antigen 125(CA125)and epidermal growth factor(EGF)for large cell lung cancer patients(LCLC).Methods:133 cases of LCLC received thoracoscopic surgery(TS)and thoracotomy(TC)were retrospectively analyzed.The surgical status,efficacy,complications and the levels of NSE,CA125 and EGF were compared.Results:The surgical time,bleeding volume,drainage tube placement time,visual analogue scale 5 days after operation and hospital stay in TS group were all significantly less than those in the TC group.But the cost of TS group was significantly more than TC group(P<0.05).All the lesions were complete resection.Auxiliary lymph node dissection status and survival rate in 2 years had no significant difference between 2 groups(P>0.05).TS group had significantly lower complication rate than TC group(P<0.05).Serum levels of NSE,CA125 and EGF were all significantly reduced in d7 after surgery compared with in d1 before surgery.EGF level of TS group was significantly lower than that of TC group in d7 after surgery(P<0.05).Conclusion:TS and TC are both efficient for LCLC patients,but TS patients have lower complication rate,smaller trauma and faster recurrence,and lower level of EGF.TS is worthy of promoting application for LCLC patients meeting the surgery indications.