关键词: 单孔, 胸腔镜, 肺叶切除术, 非小细胞肺癌, 经剑突下, 内环境

Abstract: Objective To observe and compare the effects of singleport thoracoscopic lobectomy under two approaches(transxiphoid and intercostal) on postoperative rehabilitation progress,pulmonary function and internal environment indexes of nonsmall cell lung cancer.Methods 82 patients with nonsmall cell lung cancer in Civil Aviation General Hospital were divided into two groups according to different surgical approaches.All patients underw ent single hole thoracoscopic lobectomy.43 patients in the transxiphoid group underwent transxiphoid surgery and 39 patients in the intercostal group underwent subcostal surgery.The operation conditions,complications,postoperative pain score(VAS),1 year survival rate after operation,internal environment indexes and pulmonary function indexes before and after operation were compared between the two groups.Results There was no difference in the number of lymph nodes dissected between the two groups(P>0.05).The operation time in the transxiphoid group[(151.72±28.04)min] was longer than that in the intercostal group[(137.35±24.72)min],but the hospitalization,catheter placement and ambulation time were(5.02±0.84) d,(3.91±1.47) d and(10.04±1.83) d,respectively,which were shorter than those in the transcostal group[(5.53±0.96)d,(4.86±1.72)d,(11.85±2.06)d(P<0.05)].The intraoperative blood loss,VAS score at 6h,1d,2d,and 3d after operation in the transxiphoid group were lower than those in the intercostal group(P<0.05).The levels of serum Creactive protein(CRP),interleukin 6(IL-6),and creatine kinase(CK) in the xiphoid group were(10.52±1.83) mg/L,(8.36 ±1.28) mg/L,(121.87±15.74) pg/mL,(106.90±11.82) pg/ml,(247.80±26.57) U/L,(219.74±30.09) U/L,all lower than the intercostal group(15.76±2.48)mg/L,(10.75±1.59)mg/L,(169.20±18.16)pg/ml,(132.62±15.71)pg/ml,(336.27±41.58)U/L,(292.84±34.29)U/L(P<0.05).The levels of maximum spontaneous ventilation(MVV) and forced expiratory flow in 1 second(FEV1)/forced vital capacity(FVC) in the two groups at 1 month after operation were lower than those before operation(P<0.05),but there was no difference between the groups(P>0.05).There was no difference in postoperative complication rate and 1year survival rate between the two groups(P>0.05).Conclusion Compared with the transcostal approach,Subxiphoid singleport thoracoscopic lobectomy in the treatment of nonsmall cell lung cancer is not only effective,but also can reduce surgical trauma,relieve postoperative pain,stabilize the internal environment of the body,and promote postoperative recovery.

Key words: single hole, thoracoscopy, lobectomy, non small cell lung cancer, transxiphoid process, internal environment