天津医药

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腋下小切口与传统后外侧切口肺癌切除术的对比分析

马国军1,张逊2,韩洪利2,卢喜科2,孙大强3,韩兴鹏4   

  1. 1. 天津医科大学研究生院
    2. 天津市胸科医院
    3. 天津市胸科医院胸外科，天津医科大学胸科临床学院
    4. 天津市胸科医院胸外科
  • 收稿日期:2010-05-28 修回日期:2010-08-17 出版日期:2011-01-15 发布日期:2011-01-15
  • 通讯作者: 马国军

The comparative analysis of axillary small incision and traditional posterolateral incision in the lung cancer operation

  • Received:2010-05-28 Revised:2010-08-17 Published:2011-01-15 Online:2011-01-15

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摘要： 摘要 目的：探讨腋下小切口在肺癌手术治疗中的临床价值。方法：将151例Ⅰ~Ⅲ期肺癌手术患者，分为腋下小切口组（80例）和传统后外侧切口组（71例），比较2组患者的围手术期临床指标、术前1 d和术后4 h、1 d、2 d的血清C反应蛋白（CRP）及白细胞介素（IL）-6、IL-8浓度。结果：（1）腋下小切口组在术中出血量、切口长度、术后离床时间、术后引流量、带管时间、术后住院日、术后疼痛强度评分、术后吗啡片用量、术后主要并发症方面较传统后外侧切口组均明显减少（P <0.05）。（2）与术前1 d比较，2组术后4 h、1 d、2 d时点血清CRP浓度均明显升高（P <0.05），且在术后1 d时点达高峰；与术前1 d比较，2组术后4 h、1 d、2 d时点血清IL-6,IL-8浓度均明显升高（P <0.05），且在术后4 h时点达高峰；与传统后外侧切口组相比，腋下小切口组术后4 h、1 d、2 d时点血清CRP、IL-6 及IL-8浓度均明显降低（P <0.05）。结论：腋下小切口与传统后外侧切口相比具有急性期炎性反应轻，对机体损伤小、疼痛轻、恢复快等优点，该切口能完成各种肺切除术式及系统性淋巴结清扫的要求，可作为肺癌手术治疗的常规切口。

关键词: 肺肿瘤, 癌, 胸外科手术, 肺切除术, 腋, C反应蛋白质, 白细胞介素6, 白细胞介素8

Abstract: Abstract Objective:To search for the clinical value of axillary small incision in the lung cancer surgery. Methods:From January 2009 to January 2010,151 surgery patients with stageⅠ-Ⅲ lung cancer were collected and divided into the axillary incision group (80 cases) and traditional posterolateral incision group (71 cases),The perioperative indicators and last day before operation or 4 hours,1 day,2 day after operation of serum CRP and cytokines (IL-6, IL-8) concentration were compared. Results:The axillary incision group in the intraoperative blood lose ,incision length, postoperative bed stay, drainage volume, drainage tube retention, postoperative hospital stay, postoperative pain intensity score, postoperative dosage of morphine, postoperative complications were all significantly lower than traditional posterolateral incision group (P <0.05).Compared with last day before operation , CRP was significantly increased at 4 hours,1 day,2 days after operation in both groups,and the peak value at 1 day after operation. Compared with last day before operation , IL-6 and IL-8 were significantly increased at 4 hours,1 day,2 days after operation in both groups,and the peak value at 4 hours after operation. The serum concentration of CRP and cytokines (IL-6, IL-8) at 4 hours,1 day,2 days after operation in the axillary incision group were all significantly lower than traditional posterolateral incision group (P <0.05). Conclusion:Compared with the traditional posterolateral incision, the axillary incision has lighter acute phase inflammatory reaction,less body damage, less pain, faster recovery and so on，axillary small incision can be completely meet the requirements of all kinds of pneumonoresection and systematic lymph node dissection, can be used as routine incision of lung cancer surgery.

Key words: lung neoplasms, carcinoma, thoracic surgical procedures, pneumonectomy, axilla, C-reactive protein, interleukin-6, 白细胞介素8