| Objective: lung cancer is within the scope of our country and even the world one of the most common malignant tumor,as the atmosphere environment pollution and smoking people increasingly younger age,morbidity rising trends in recent years,because of early lung cancer patients without typical clinical symptoms obviously,causing most of the patients with lung cancer diagnosed when has lost the best treatment time,case fatality rate is high,has the serious influence people’s health level in our country.As clinical chemotherapy drugs continuously upgrading and molecular targeted drugs for lung cancer treatment matures,offers a variety of choice for lung cancer treatment,but there is no denying that surgery is still the first choice for treatment of lung cancer,traditional thoracotomy surgical trauma,hemorrhage,the postoperative cardiopulmonary function of patients with severe thoracic surgery is a clinical doctor consensus,and studies show thoracoscope surgery with small trauma,less bleeding,fast recovery of mediastinal lymph nodes,lung door also can be standardized cleaning,can achieve the traditional open heart surgery is the same effect.In recent years,with people’s increasingly attention to health physical examination,imaging technology development,especially HRCT is widely used in clinical,more and more to the discovery of early lung cancer cases,compared with the traditional lobectomy surgery,the basis for lung cancer with long-term smoking and chronic diseases will increase the risk of postoperative cardiopulmonary complications.However,the clinical efficacy of lung section resection in early lung cancer is controversial.This research mainly comparative analysis in patients with lung cancer early application of thoracoscope assisted small incision,vats lobectomy and thoracoscope lung resection in three different surgical perioperative indicators and therapeutic effect.Methods: A total of 120 patients with early lung cancer were selected as the subjects,and 38 cases were divided into thoracoscope assisted small incision lobectomy(group A).Thoracoscopic lobectomy(group B): 42 cases;Under total thoracoscopy pulmonary segment resection of 40 cases(group C),three groups of patients by Chest CT before operation(Chest computed tomography,CCTS)clear lung space-occupying lesions,clinical diagnosis of lung cancer and preoperative clinical staging for Ⅰ period,postoperative specimens of lung tissue pathology diagnosed with non-small cell lung cancer(Non-small cell lung cancer,NSCLC)patients.After careful preoperative examination,surgical contraindications were performed and preoperative airway preparation was performed.Into the operating room open immediately after venous pathway,monitoring ECG(electrocardiogram,ECG)and heart rate(heartte,HR),noninvasive arterial blood pressure(non-invasive blood pressure,NIBP)and pulse oxygen saturation(saturation of pulse oxygen,Sp O2).All patients with double cavity or single lumen endotracheal intubation with closure,static absorption composite satisfaction after general anesthesia,conventional put fixed surgery position(left and right lateral position,high ribs pad),disinfection,shop towel,to start the operation.Group A surgery in patients with bilateral axillary midline intercostals cut A long about 2.0 7 cm incision,put stamp card,as the cavity mirror observation hole,probe the pleural cavity mirror,determine the size of the tumor tissue,the location and pleural adhesion situation,cut in the ipsilateral axillary front rib between 4 A small incision,about 5-7 cm will contain cancerous tissue lung pulmonary vein,pulmonary and bronchial separation,and to cut off the ligation,will contain lung cancer of lung resection,and then for mediastinal lymph node cleaning.Group B patients in surgical side axillary midline cut 7th floor one is about 2.0 cm long as cavity mirror observation hole,into the cavity mirror after exploration,respectively,in the fourth rib and between the trailing edge,the latissimus dorsi muscle pectoralis major front do incision,5 cm in diameter,as main operating hole cavity mirror,on the 7th floor to do a 1.5 cm incision as cavity mirrors vice hole operation,use the Endo-GIA cutting designer will pulmonary arteriovenous,bronchus,not all from broken fissures.The pulmonary lobe containing lung cancer was excised completely and then mediastinal lymph node dissection was performed.Patients of group C process into the chest and operating hole position and group B are the same,after clear lesions in pulmonary segment,the anatomy of the separation of pulmonary arteriovenous and paragraphs bronchus,period of arteriovenous and bronchial use the Endo-GIA cutting sewing machine is broken,it clear lung boundary,will contain a complete resection lung lesions of lung segment,intraoperative frozen lymph node sampling and sampling.Three groups of patients completed the operation successfully,and compared the perioperative indicators of the three groups: operation time,length of hospital stay,intraoperative blood loss and postoperative thoracic drainage;The indexes of lung function were compared in three groups: the first second forced expiratory volume(FEV1),the maximum amount of gas(MVV),and the forced lung capacity(FVC).The postoperative complications of the three groups were recorded: lung,pulmonary infection,arrhythmia,and bronchial pleural fistula;There were no tumor recurrence and metastasis in the median follow-up period of 15 months in the three groups.For the data from studies using SPSS18.0 statistical software was used to statistical analysis,measurement data + s,USES the F test,counting data expressed as a proportion of the number of cases,with x2 test,P < 0.05 said have statistical significance.Results: the basic data of the three groups showed no significant difference and had good comparability.In group B and C,the index of perioperative period was lower than that of group A(P < 0.05),and postoperative thoracic drainage in group C was lower than that in group B(P < 0.05).The lung function indexes in group A were lower than those in group B and group C(P < 0.05),and the lung function indexes in group C were higher than those in group B(P < 0.05).The incidence of postoperative complications in group B and C was lower than that in group A(P < 0.05),and P < 0.05 was statistically significant.No recurrence or metastasis was found in the median follow-up of the three groups for 15 months(12-18 months).Conclusion: for early lung cancer treatment,the thoracoscope lung resection is lobectomy can reduce postoperative pleural effusion and better protect pulmonary function,no difference between the prognosis and survival,clinical curative effect is positive. |
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