胸腔镜和开放肺叶切除术对肺癌患者心肺运动耐力的影响
Cardio-pulmonary Exercise Capacity in Patients with Lung Cancers: a Comparison Study Between Video-assisted Thoracoscopic Lobectomy and Thoracotomy Lobectomy
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摘要: 目的 研究常规开胸和电视胸腔镜肺叶切除术对肺癌患者术后心、肺运动耐力的影响,探讨微创手术在促进肺快速康复和改善患者生活质量中的作用。 方法 从2010年9月至2011年12月连续138例肺癌患者分为开胸组(70例)和电视胸腔镜(VATS)肺叶切除组(68例),两组患者临床特征相似。检测患者术前、术后第7 d和第30 d肺功能及心肺康复运动耐力的相关指标,其中DE Morton指数以圣乔治问卷(术后第7 d和第30 d)进行分析。 结果 ①术后第7 d VATS组第1 s用力呼气容积(FEV1)和峰值呼气流量(PEF)实测值(1.64±0.21) L,(310.58±30.13) L/min高于开胸组(1.34±0.11) L,(270.18±25.67) L/min,P<0.05;②术后第7 d VATS组疲劳指数和呼吸困难指数(0.27±0.08, 0.28±0.17)均低于开胸组(0.44±0.10,0.39±0.09),P<0.05;③术后第7、30 d VATS组6 min步行距离(490.57±118.33) m,(524.32±140.87) m均高于开胸组(395.07±100.19) m,(471.10±118.57) m,P<0.05。④术后第7 d VATS组DE Morton指数(74.58±16.23)高于开胸组(55.87±14.79),P<0.05;⑤术后引流管时间VATS组(25.96±15.42) h短于开胸组(41.84±21.24) h,P<0.05;术后住院时间VATS组(3.14±2.31) d短于开胸组(5.91±4.24) d,P<0.05;平均住院日VATS组(6.54±2.76) d短于开胸组(9.67±4.31) d,P<0.05。 结论 电视胸腔镜肺叶切除提高心肺功能,改善运动耐力而促进快速恢复并提高肺癌患者术后的生活质量。Abstract: Objective To determine the effect of video-assisted thoracoscopic lobectomy on the pulmonary rehabilitation of patients with lung cancers. Methods Between September 2010 and December 2011, 138 patients with lung cancers were treated with lobectomy:68 using video-assisted thoracoscopic surgery (VATS) and 70 using thoracotomy. The preoperative and postoperative (7 d and 30 d) pulmonary functions and Cardio-pulmonary Exercise Capacities as well as postoperative (7 d and 30 d) DE Morton Index of the two groups of patients were assessed. The two groups of patients had similar in clinical characteristics. Results ① Patients in the VATS group had greater FEV1 (1.64 ±0.21) L and PEF(310.58±30.13) L/min on the 7 d after operations than those with thoracotomyFEV1 (1.34±0.11) L and PEF (270.18±25.67) L/min,P<0.05. ② Patients in the VATS group had lower fatigue index (0.27±0.08) and dyspnea index (0.28±0.17) on the 7 d after operations than those with thoracotomy (0.44±0.10 fatigue index and 0.39±0.09 dyspnea index),P<0.05. ③ Patients in the VATS group had longer 6-min walking distance on the 7 d(490.57±118.33) m and 30 d(524.32±140.87) m after operations than those with thoracotomy(395.07±100.19) m at 7 d and (471.10±118.57) m at 30 d,P<0.05. ④ Patients in the VATS group had higher DE Morton index (74.58±16.23) on the 7 d after operations than those with thoracotomy (55.87±14.79),P<0.05. Conclusion VATS lobectomy for curative lung cancer resection appears to provide a superior functional health recovery compared with thoracotomy.