The Research Of Risk Factors For Early Lung Adenocarcinoma In Non-smoking Women And Clinical Effect Analysis Of Different Surgical Methods

Part 1 The Research of risk factors for early lung adenocarcinoma in non-smoking womenObjectiveTo evaluate and analyze the risk factors for non-smoking female patients with early lung adenocarcinoma diagnosed by thoracic surgery in our hospital comprehensively.MethodThis part of the study adopts the statistical method of case-control study,and the case population and control population are matched 1:1.The clinical data of 356 female patients with stage IA lung adenocarcinoma who underwent surgical treatment in the Department of Thoracic Surgery of Northern Jiangsu People’s Hospital from January 2015 to January 2021 were included in the experimental group.The control group was randomly selected from the non-smoking healthy female population living in Yangzhou urban area for a long time.A total of 356 cases were screened.The exposure history of risk factors was collected by consulting medical records,e-form collection,wechat communication,telephone follow-up,etc.Univariate and multivariate Logistic regression models were used for analysis to screen the main risk factors of early lung adenocarcinoma in non-smoking women.Result1.A total of 356 non-smoking female patients with lung adenocarcinoma participated in the questionnaire survey according to the research objectives and screening conditions,and 356 healthy non-smoking female controls were screened according to the matching requirements.The age distribution of the experimental group ranged from 27 to 84 years old,with an average age of 59.14 ±9.71 years old.The age range of the control group was 25-81 years old,and the average age was 58.47±12.05 Years old.After statistical analysis,there was no significant difference between the experimental group and the control group in age,marital status,educational level,economic income and basic diseases（P>0.05）.2.Univariate analysis showed that kitchen smoke exposure（severe）,pickled food intake>7 times/week,passive smoking（moderate）,passive smoking（severe）,pesticide exposure>3 times/week,and history of chronic lung disease were risk factors for early lung adenocarcinoma in non-smoking women（P<0.05,OR value>1）.Intake of fresh fruits and vegetables 4 to 7 times/week and intake of fresh fruits and vegetables>7 times/week were protective factors for early lung adenocarcinoma in non-smoking women（P<0.05,OR value<1）.3.Multivariate analysis showed that kitchen smoke exposure（severe）,pickled food intake>7 times/week,passive smoking（moderate）,passive smoking（severe）,chronic lung disease history were risk factors for early lung adenocarcinoma in non-smoking women（P<0.05,OR value>1）.Intake of fresh fruits and vegetables>7 times/week was a protective factor for early lung adenocarcinoma in non-smoking women（P<0.05,OR value<1）.Conclusion1.According to this study,the risk factors for early lung adenocarcinoma in nonsmoking women were found to be kitchen smoke exposure>7 times/week,pickled food intake>7 times/week,passive smoking>4 times/week,and history of chronic lung disease.Protective factors were:intake of fresh fruits and vegetables>7 times per week.2.In view of the above factors,active and effective measures should be taken in time to improve the prognosis of patients;Reduce the incidence rate,improve the cure rate,and really give "early detection,early diagnosis,early treatment" realistic significance and practical value.Part 2 Clinical effect analysis of different surgical methods in the treatment of early lung adenocarcinoma in non-smoking womenObjectiveTo investigate the clinical effect of thoracoscopic segmentectomy and lobectomy in the treatment of early lung adenocarcinoma in non-smoking women.MethodA retrospective analysis was performed on the clinical data of 319 female patients who underwent surgical treatment in the Department of Thoracic Surgery of Northern Jiangsu People’s Hospital from January 2015 to January 2021,and the postoperative pathology was confirmed to be Stage IA invasive lung adenocarcinoma.After admission,relevant routine preoperative examinations were completed for all patients and operation-related contraindications were excluded.According to different surgical methods,198 cases were divided into VATS lobectomy group and 121 cases were VATS segmental resection group.The operative time,intraoperative blood loss,postoperative thoracic drainage volume,postoperative indwelling time of thoracic catheter,postoperative hospital stay,total number of lymph node dissection,pain score on the first postoperative day and the day before discharge,and incidence of postoperative complications in 2 groups were observed and recorded.Result1.Comparison of general data:198 cases（62.1%）in the VATS lobectomy group and 121 cases（37.9%）in the VATS segmental pulmonary resection group.In lung segment group,50 patients（41.4%）had left upper lobe,25 patients（20.7%）had left lower lobe,33 patients（27.2%）had right upper lobe,and 13 patients（10.7%）had right lower lobe.Average age:63.89±9.32 years.In the pulmonary lobe group,45 cases（22.7%）had left upper lobe,39 cases（19.7%）had left lower lobe,64 cases（32.3%）had right upper lobe,13 cases（6.6%）had right middle lobe,and 37 cases（18.7%）had right lower lobe.The mean age was 60.92±7.80 years.There was no significant difference in age and underlying diseases between the two groups（P>0.05）.2.Comparison of perioperative data:The postoperative thoracic drainage flow,postoperative indenture time of thoracic catheter,postoperative hospital stay and total number of lymph node dissection in VATS pulmonary segmentectomy group were all less than those in VATS pulmonary segmentectomy group,the differences were statistically significant（P<0.05）.There was no significant difference in operation time,intraoperative blood loss,pain score on the first day after surgery and pain score on the day before discharge between the two groups（P>0.05）.3.Comparison of postoperative complications:there was no statistical difference in the incidence of postoperative pulmonary infection,arrhythmia,persistent lung leakage,chylothorax,pulmonary embolism and other complications between the VATS pulmonary segmentectomy group and the VATS lobotomy group（P>0.05）.Conclusion1.Both VATS lobectomy and VATS segmentectomy can achieve satisfactory perioperative efficacy.2.Compared with VATS lobectomy,VATS segmental pulmonary resection has the advantages of less postoperative drainage,shorter postoperative chest drainage tube placement time and shorter postoperative hospital stay,which can provide a more minimally invasive and effective thoracic surgical treatment for women with early non-smoking lung adenocarcinoma.