目的:比较胸腔镜和开放性肺叶切除对高龄非小细胞肺癌患者术后应激反应和呼吸功能的影响.方法:回顾分析我院2011年1月至2017年1月收治的高龄非小细胞肺癌患者92例,其中观察组46例采用胸腔镜下肺叶切除术,对照组46例采用开放性肺叶切除术,比较两组患者手术情况、术后应激反应、呼吸功能、康复情况和术后并发症.结果:两组患者术前促肾上腺皮质激素和 C反应蛋白差异无统计学差异(P＞0.05).术后24小时与对照组比较,观察组患者促肾上腺皮质激素显著降低[(4.18 ± 0.98)ng/ml vs (4.92 ± 1.09)ng/ml,P＝0.001];C反应蛋白显著降低[(12.94 ± 2.46)mg/L vs (17.68 ± 2.62)mg/L,P＝0.000].两组患者术前用力肺活量和呼气峰值流速等差异无统计学意义(P＞0.05).术后24小时与对照组比较,观察组用力肺活量显著升高[(2.18 ± 0.44)L vs (1.98 ± 0.36)L,P＝0.019];呼气峰值流速显著增高[(331.72 ± 29.91)L/min vs (294.74 ± 28.87)L/min,P＝0.000].与对照组比较,观察组患者肛门排气时间显著缩短[(72.81 ± 9.21)h vs (78.74 ± 9.59)h,P＝0.003];住院时间显著缩短[(11.96 ± 1.86)d vs (12.92 ± 1.84)d,P＝0.015];术中出血量显著减少[(244.91 ± 37.62)ml vs (299.74 ± 41.48)ml,P＝0.000].结论:胸腔镜下肺叶切除术有助于降低高龄非小细胞肺癌患者术后应激反应,改善患者呼吸功能,加速患者术后康复.%Objective:To compare the effects of thoracoscopy and open lobectomy on stress response and respirato-ry function in elderly patients with non-small cell lung cancer.Methods:From January 2011 to January 2017,92 ca-ses of elderly patients with non-small cell lung cancer patients were retrospectively analyzed,the observation group of 46 cases with thoracoscopic lobectomy,46 cases in the control group using traditional open surgery.The operation situ-ation,postoperative stress response,respiratory function,rehabilitation and postoperative complications of the two groups were compared.Results:There were no differences between the two groups in adrenocorticotrophin and C reac-tive protein between the two groups before the operation (P＞0.05).At 24 hours after the operation,when compared with the control group,patients in the observation group got a decreased level of adrenocorticotrophin [(4.18 ± 0.98) ng/ml vs (4.92 ±1.09)ng/ml,P＝0.001]and a reduction in C reactive protein [(12.94 ± 2.46)mg/L vs (17.68 ± 2.62)mg/L,P＝0.000].There were no significant difference in preoperative forced vital capacity and peak expiratory flow rate between the two groups (P＞0.05).At 24 hours after the operation,when compared with the control group,patients in the observation group got a higher forced vital capacity [(2.18 ± 0.44)L vs (1.98 ± 0.36)L,P＝0.019]and an elevated peak expiratory flow rate [(331.72 ± 29.91)L/min vs (294.74 ± 28.87) L/min,P＝0.000].When compared with the control group,patients in the observation group got a shorter anal ex-haust time [(72.81 ± 9.21)h vs (78.74 ± 9.59)h,P＝0.003].A shorter hospital duration [(11.96 ± 1.86)d vs (12.92 ± 1.84)d,P ＝0.015]and a lower amount of bleeding during the operation [(244.91 ± 37.62)ml vs (299.74 ± 41.48)ml,P＝0.000].Conclusion:Thoracoscopic lobectomy is helpful to reduce the elderly postopera-tive stress response in patients with non-small cell lung cancer,improve the respiratory function,and accelerate the rehabilitation after operation.
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