关键词: 胸腔镜；肺叶切除；解剖性肺段切除；肺楔形切除；非小细胞肺癌

Abstract: Objective To compare the efficacy of thoracoscopic lobectomy,wedge resection and anatomical segmental resection in the treatment of non-small cell lung cancer (NSCLC).Methods 81 patients with NSCLC admitted to our hospital from August 2017 to August 2019 were randomly divided into lobectomy group,segmental resection group and wedge resection group,with 27 patients in each group.The operation conditions (including perioperative conditions,lung function,inflammatory factors,immune function,complications) and prognosis (3-year recurrence rate and distant metastasis rate) of the three groups were compared.Results Compared with the lobectomy group,the specific operation time,drainage volume,and hospitalization days of the segmentectomy group were significantly reduced(P<0.05).Compared with the segmentectomy group,the specific operation time,drainage volume,and hospitalization days of the wedge resection group were significantly reduced(P<0.05).Before surgery,there was no difference in immune function indicators among the three groups(P>0.05).Four weeks after operation,CD4+,CD4+/CD8+,forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1),maximum ventilation volume per minute(MVV),and carbon monoxide diffusing capacity(DLCO)in the segmentectomy group were significantly higher than those in the lobectomy group(P<0.05),CD8+,interleukin-6(IL-6),and C-reactive protein(CRP)in the segmentectomy group were significantly lower than those in the lobectomy group(P<0.05).CD4+,CD4+/CD8+,FVC,FEV1,MVV,and DLCO in the wedge resection group were significantly higher than those in the segmentectomy group(P<0.05),and CD8+,IL-6,and CRP in the wedge resection group were significantly lower than those in the segmentectomy group(P<0.05).There was no difference in the 3-year distant metastasis rate and recurrence rate among the three groups(P>0.05).Compared with the lobectomy group,the incidence of various postoperative complications in the wedge resection group and segmental resection group was slightly lower,but there was no difference in comparison (P>0.05).Conclusion Among the three surgical methods,pulmonary wedge resection has relatively small adverse effects on lung function,inflammation and immunity of NSCLC patients,and the postoperative recovery is relatively fast,followed by anatomical segmental resection,and finally lobectomy.There is no significant difference in complications and long-term prognosis among the three.

Key words: thoracoscope; lobectomy; anatomical segmental resection of lung; lung wedge resection; non-small cell lung cancer