胸腺肽联合胸腔镜根治术治疗老年早期肺癌患者的疗效及生存分析
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摘要
目的研究胸腺肽联合胸腔镜根治术对老年早期肺癌患者的疗效及生存期的影响。方法选取136例老年早期肺癌患者,根据手术方法不同将患者分为观察组和对照组,每组68例,观察组采用胸腺肽联合胸腔镜手术,对照组采用传统开胸手术,观察比较两组患者围手术期指标、免疫细胞水平以及生存率、复发率、不良反应发生率。结果观察组患者手术时间、拔除引流管时间、术后下床时间及住院时间均明显短于对照组患者,手术出血量明显少于对照组患者,差异均有统计学意义(P﹤0.01)。手术前,两组患者免疫细胞CD4~+、CD8~+、CD4~+/CD8~+、CD3~+、自然杀伤细胞(NK)水平比较,差异均无统计学意义(P﹥0.05);手术后,两组患者免疫细胞CD4~+、CD8~+、CD4~+/CD8~+、CD3~+、NK水平均较本组手术前下降,且对照组患者CD4~+、CD8~+、CD4~+/CD8~+、CD3~+、NK水平均低于观察组,差异均有统计学意义(P﹤0.05)。观察组患者1年、2年、3年生存率均明显高于对照组,差异均有统计学意义(P﹤0.01);观察组患者复发率低于对照组,差异有统计学意义(P﹤0.05)。观察组患者治疗后总不良反应发生率低于对照组,差异有统计学意义(P﹤0.05)。结论胸腺肽联合胸腔镜手术治疗老年早期肺癌患者临床疗效显著,患者出血量少,免疫细胞水平波动较小,生存率高,值得临床推广应用。
Objective To observe the effect of thymosin combined with thoracoscopic surgery on curative effect and survival time of elderly patients with early stage lung cancer after radical operation. Method A total of 136 elderly patients with early stage lung cancer who underwent surgery were included in the research as study group and control group, with 68 cases in each, respectively, patients in study group were administered with thymosin combined with thoracoscopic surgery, while those in the control group were given traditional thoracotomy, the perioperative operative factors,level of immune cells, survival rate, recurrence rate and the incidence of adverse reactions were observed and compared between the two groups. Result The operative time, time of chest tube removal, time to postoperative ambulation, and length of stay in hospital were shorter in study group than those in control group, in addition, patients in study group had less intraoperative blood loss compared with control group(P<0.01); before surgery, there were no significant differences between the two groups of patients in regard with level of CD4+, CD8+, CD4+/CD8+, CD3+, and NK cells(P>0.05); after surgery, the level of immune cells above decreased in both groups, and those in control group were significantly lower than that in study group(P<0.05). The 1-, 2-, and 3-year survival rates were significantly higher in study group than in control group(P<0.01); as for the recurrence, lower rate was observed in study group compared with control group(P<0.05). Additionally, the study group showed lower overall incidence of adverse reactions than that in control group, with statistically significant difference observed(P<0.05). Conclusion Thymosin combined with thoracoscopic surgery for elderly patients with early stage lung cancer receiving radical resection is clinically effective, with less blood loss, minor fluctuation of immune cell level, and higher survival rate, which is clinically applicable.
Objective To observe the effect of thymosin combined with thoracoscopic surgery on curative effect and survival time of elderly patients with early stage lung cancer after radical operation. Method A total of 136 elderly patients with early stage lung cancer who underwent surgery were included in the research as study group and control group, with 68 cases in each, respectively, patients in study group were administered with thymosin combined with thoracoscopic surgery, while those in the control group were given traditional thoracotomy, the perioperative operative factors,level of immune cells, survival rate, recurrence rate and the incidence of adverse reactions were observed and compared between the two groups. Result The operative time, time of chest tube removal, time to postoperative ambulation, and length of stay in hospital were shorter in study group than those in control group, in addition, patients in study group had less intraoperative blood loss compared with control group(P<0.01); before surgery, there were no significant differences between the two groups of patients in regard with level of CD4+, CD8+, CD4+/CD8+, CD3+, and NK cells(P>0.05); after surgery, the level of immune cells above decreased in both groups, and those in control group were significantly lower than that in study group(P<0.05). The 1-, 2-, and 3-year survival rates were significantly higher in study group than in control group(P<0.01); as for the recurrence, lower rate was observed in study group compared with control group(P<0.05). Additionally, the study group showed lower overall incidence of adverse reactions than that in control group, with statistically significant difference observed(P<0.05). Conclusion Thymosin combined with thoracoscopic surgery for elderly patients with early stage lung cancer receiving radical resection is clinically effective, with less blood loss, minor fluctuation of immune cell level, and higher survival rate, which is clinically applicable.
引文
[1]王建东,左占杰,张洪波,等.电视辅助胸腔镜手术和体部立体定向放疗治疗早期非小细胞肺癌的临床疗效比较[J].中国肺癌杂志, 2016, 19(3):136-146.
[2]王沐廷,郑滢丽,林晓旋,等.非小细胞肺癌胸腔镜手术围术期血清白蛋白和乳酸水平的变化及意义[J].广东医学,2016, 37(8):1157-1160.
[3]马建强,杨绍军,李旭,等.全胸腔镜与传统开胸肺癌根治术的比较[J].中国微创外科杂志, 2016, 16(9):802-806.
[4]吕广超,王凯忠,阿旺丹增,等. 70岁以上肺癌患者胸腔镜与传统开胸术后心律失常发生的比较[J].中国老年学杂志, 2014, 34(2):486-488.
[5] Servais E, Swanson SJ. Thoracoscopic management of pulmonary metastases[J]. Thorac Surg Clin, 2016, 26(1):91-97.
[6]郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究[J].中国肺癌杂志, 2016, 19(3):122-128.
[7]王希文,赵俊刚.单孔胸腔镜肺癌根治术与传统三孔手术的对比分析[J].重庆医学, 2016, 45(28):3959-3961; 3964.
[8]刘阳,张为迪,刘希斌,等.单孔全胸腔镜手术在胸部肿瘤治疗中的应用[J].山东医药, 2016, 56(10):72-73.
[9]李震宇,张磊冰,王俊,等.胸腔镜治疗老年早期肺癌围术期心肺并发症危险因素分析[J].重庆医学, 2016, 45(22):3055-3056; 3059.
[10] Gajra A, Akbar SA, Din NU. Management of lung cancer in the elderly[J]. Clin Geriatr Med, 2016, 32(1):81-95.
[11]郭晓斌,李晓,冯可青.老年早期非小细胞肺癌患者外周血中鳞状细胞癌相关抗原、癌胚抗原及细胞角蛋白19血清片段21-1水平的变化[J].中国老年学杂志, 2017, 37(4):920-921.
[12]李家琳,李骋,陈武飞,等.高危人群早期肺癌LDCT基线筛查研究[J].放射学实践, 2017, 32(3):233-236.
[13]王煜东,刘军,张苏宁.单孔胸腔镜手术在老年患者肺切除术中的应用[J].中国医科大学学报, 2017, 46(3):241-243.
[14]王光锁,王正,王健,等.单孔全胸腔镜手术:单中心连续106例回顾分析[J].中国内镜杂志, 2014, 20(2):118-123.
[15] Demmy TL. Thoracoscopic lung suffusion[J]. Thorac Surg Clin, 2016, 26(1):109-121.
[16]苗栓林,李伟,李仁栓,等.胸腔镜手术与开胸手术治疗肺转移瘤的比较研究[J].临床肺科杂志, 2017, 22(7):1225-1227.
[17]李冬,沈琦斌,李鸿伟,等.胸腔镜肺癌根治术65例临床分析[J].浙江医学, 2014, 36(11):991-992.
[18]李文兵,高德伟,卢文宁,等. 80岁以上老年非小细胞肺癌切除术后并发症及预后分析[J].解放军医学杂志,2014, 39(10):823-825.
[19]周松林,徐文波.胸腔镜下手术对肺癌患者血流动力学及免疫功能的影响[J].中国内镜杂志, 2015, 21(4):344-347.
[20]李晓亮,谢晓阳,杨彦辉,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者创伤指标、免疫功能及生活质量的影响[J].临床肺科杂志, 2017, 22(7):1189-1192.
[21]杨欣,曾兴建,付娟.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者的早期创伤指标及免疫功能的影响[J].实用临床医药杂志, 2016, 20(19):86-87; 90.
[22]郝青,刘玮,任建新,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者的早期创伤指标及免疫功能的影响[J].河北医药, 2016, 38(13):1943-1945.
[23]乔坤,彭彬,黄代强,等.加速康复外科联合全胸腔镜在肺癌病人根治术中的应用研究[J].肠外与肠内营养,2016, 23(2):99-102.
[24]叶韶峰,吴明.电视胸腔镜手术治疗老年早期肺癌的效果及对患者生活质量的影响[J].中国老年学杂志, 2017,37(10):2482-2483.
[25]李放,葛宏雷,金昊.电视辅助胸腔镜手术和体部立体定向放疗治疗早期非小细胞肺癌的临床疗效比较[J].临床和实验医学杂志, 2017, 16(10):1008-1010.
[2]王沐廷,郑滢丽,林晓旋,等.非小细胞肺癌胸腔镜手术围术期血清白蛋白和乳酸水平的变化及意义[J].广东医学,2016, 37(8):1157-1160.
[3]马建强,杨绍军,李旭,等.全胸腔镜与传统开胸肺癌根治术的比较[J].中国微创外科杂志, 2016, 16(9):802-806.
[4]吕广超,王凯忠,阿旺丹增,等. 70岁以上肺癌患者胸腔镜与传统开胸术后心律失常发生的比较[J].中国老年学杂志, 2014, 34(2):486-488.
[5] Servais E, Swanson SJ. Thoracoscopic management of pulmonary metastases[J]. Thorac Surg Clin, 2016, 26(1):91-97.
[6]郝志鹏,蔡奕欣,付圣灵,等.单孔与三孔胸腔镜肺癌根治术对患者术后疼痛及短期生活质量的对比研究[J].中国肺癌杂志, 2016, 19(3):122-128.
[7]王希文,赵俊刚.单孔胸腔镜肺癌根治术与传统三孔手术的对比分析[J].重庆医学, 2016, 45(28):3959-3961; 3964.
[8]刘阳,张为迪,刘希斌,等.单孔全胸腔镜手术在胸部肿瘤治疗中的应用[J].山东医药, 2016, 56(10):72-73.
[9]李震宇,张磊冰,王俊,等.胸腔镜治疗老年早期肺癌围术期心肺并发症危险因素分析[J].重庆医学, 2016, 45(22):3055-3056; 3059.
[10] Gajra A, Akbar SA, Din NU. Management of lung cancer in the elderly[J]. Clin Geriatr Med, 2016, 32(1):81-95.
[11]郭晓斌,李晓,冯可青.老年早期非小细胞肺癌患者外周血中鳞状细胞癌相关抗原、癌胚抗原及细胞角蛋白19血清片段21-1水平的变化[J].中国老年学杂志, 2017, 37(4):920-921.
[12]李家琳,李骋,陈武飞,等.高危人群早期肺癌LDCT基线筛查研究[J].放射学实践, 2017, 32(3):233-236.
[13]王煜东,刘军,张苏宁.单孔胸腔镜手术在老年患者肺切除术中的应用[J].中国医科大学学报, 2017, 46(3):241-243.
[14]王光锁,王正,王健,等.单孔全胸腔镜手术:单中心连续106例回顾分析[J].中国内镜杂志, 2014, 20(2):118-123.
[15] Demmy TL. Thoracoscopic lung suffusion[J]. Thorac Surg Clin, 2016, 26(1):109-121.
[16]苗栓林,李伟,李仁栓,等.胸腔镜手术与开胸手术治疗肺转移瘤的比较研究[J].临床肺科杂志, 2017, 22(7):1225-1227.
[17]李冬,沈琦斌,李鸿伟,等.胸腔镜肺癌根治术65例临床分析[J].浙江医学, 2014, 36(11):991-992.
[18]李文兵,高德伟,卢文宁,等. 80岁以上老年非小细胞肺癌切除术后并发症及预后分析[J].解放军医学杂志,2014, 39(10):823-825.
[19]周松林,徐文波.胸腔镜下手术对肺癌患者血流动力学及免疫功能的影响[J].中国内镜杂志, 2015, 21(4):344-347.
[20]李晓亮,谢晓阳,杨彦辉,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者创伤指标、免疫功能及生活质量的影响[J].临床肺科杂志, 2017, 22(7):1189-1192.
[21]杨欣,曾兴建,付娟.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者的早期创伤指标及免疫功能的影响[J].实用临床医药杂志, 2016, 20(19):86-87; 90.
[22]郝青,刘玮,任建新,等.全胸腔镜与后外侧开胸手术对非小细胞肺癌患者的早期创伤指标及免疫功能的影响[J].河北医药, 2016, 38(13):1943-1945.
[23]乔坤,彭彬,黄代强,等.加速康复外科联合全胸腔镜在肺癌病人根治术中的应用研究[J].肠外与肠内营养,2016, 23(2):99-102.
[24]叶韶峰,吴明.电视胸腔镜手术治疗老年早期肺癌的效果及对患者生活质量的影响[J].中国老年学杂志, 2017,37(10):2482-2483.
[25]李放,葛宏雷,金昊.电视辅助胸腔镜手术和体部立体定向放疗治疗早期非小细胞肺癌的临床疗效比较[J].临床和实验医学杂志, 2017, 16(10):1008-1010.