Effect Of Different Pneumonectomy Methods Under Single-port Thoracoscope On Postoperative Lung Function Of Early NSCLC

Objectives:Surgical resection is one of the most effective ways to treat early non-s mall cell lung cancer.Single-port thoracoscopic surgery can effectively reduce the tra uma to patients and is an important breakthrough in minimally invasive surgery.How ever,the effects of different pneumonectomy methods under single-port thoracoscop y on lung function are still controversial.The purpose of this study is to explore the ef fects of single-port thoracoscopic lobectomy,segmental resection and wedge resectio n on lung function and analyze the influence of related factors on postoperative lung f unction.Methods:In this study,203 patients with early non-small cell lung cancer who und erwent single-port thoracoscopic lobectomy,segmental resection and wedge resectio n were collected.Collect information about age,sex,smoking history,operation mod e,BMI,history of cardiovascular disease,lung function related indicators FEV1,FV C,MVV and so on.The recovery of lung function was followed up for 3 months an d 6 months after operation,and the effects of lobectomy and sub-lobectomy(segment al resection and wedge resection)on lung function were compared,and the influenc e of related factors on lung function recovery was further explored.Resuls:1.Comparison of lung function after lobectomy,segmental resection and wedg e resection: The lung functions(FVC,FVC%,FEV1,FEV1%,MVV,MVV%)of pati ents after lobectomy and segmental resection were significantly decreased compare d with those before operation(P < 0.05).Compared with the preoperative lung functio ns,FVC,FEV1,MVV% after wedge resection in three months and six months after o peration.2.Comparison of lung function among the three groups after lobectomy,segmen tal resection and pulmonary wedge resection: At three months after operation,the dec rease of FVC,FVC%,FEV1,FEV1%,MVV and MVV% after lobectomy was signifi cantly greater than that after segmental resection and pulmonary wedge resectio n(P < 0.01);FVC,FVC%,FEV1,FEV1% decreased more after segmental pneumone ctomy than wedge pneumonectomy(P < 0.05).Half a year after operation,FVC,FV C%,FEV1,FEV1%,MVV and MVV% after lobectomy were significantly higher tha n those after segmental resection and wedge resection(P < 0.01),and FVC and FV C% decreased more after segmental resection than those after wedge resection(P < 0.05).3.Comparison of the average loss of lung function per lung segment: The numbe r of lung segments removed by lobectomy and segmental resection were(3.64 0.98,1.10 0.31,P < 0.05)respectively.At three months and half a year after operation,the av erage loss rate of FVC and FEV1 per lung segment after segmental resection was high er than that after segmental resection,and the difference between the two groups wa s statistically significant(P < 0.05.There was no statistical difference in the average l oss rate of MVV between the two groups(P > 0.05).4.Comparison of different preoperative basic lung functions: When preoperative FE V1%≥80%,the retention rate of FVC and FEV1 in half a year after operation was sig nificantly different between lobectomy and segmental resection(P < 0.01),but ther e was no statistical difference between segmental resection and pulmonary wedge rese ction(P > 0.05);When preoperative 60% ≤ FEV1% < 80%,there was no statistical di fference in the retention rate of FVC and FEV1 between lobectomy and segmental res ection(P > 0.05),but there was a statistical difference in the retention rate of FVC an d FEV1 between segmental resection and pulmonary wedge resection(P < 0.05).5.Smoking history,history of cardiovascular and cerebrovascular diseases,age a nd BMI have no statistical difference on lung function(P > 0.05).There was significa nt difference in FVC retention rate with or without chemotherapy after operatio n(P < 0.05).Conclusions:1.There is an advantage in lung function preservation after pneumonectomy com pared with lobectomy,but there is no significant difference in lung function preservati on between pneumonectomy and lobectomy in patients with poor basic lung function before operation.2.The pulmonary function of pulmonary wedge resection was not significantly l ower than that before operation at three months after operation,while that of segment al resection and lobectomy was significantly lower than that before operation at three months after operation,and there was no significant change in the pulmonary function of the three operations at six months after operation compared with that at three mont hs after operation.3.The average loss of lung function in segmental resection is more than that in lo bectomy,which is about twice as much as that in lobectomy,which is of guiding signi ficance in determining the resection range of early lung cancer.4.Chemotherapy will have a negative impact on the recovery of FVC after opera tion.5.In single-port thoracoscopic surgery,pulmonary wedge resection has the most significant effect on preserving lung function.