全胸腔镜下肺叶切除联合系统淋巴清扫对肺癌患者血清疼痛相关因子和免疫功能的影响及预后的影响因素分析

摘要 目的：探讨全胸腔镜下肺叶切除（VATS）联合系统淋巴清扫对肺癌患者血清疼痛相关因子和免疫功能的影响，并分析预后的影响因素。方法：选择我院于2014年3月~2016年3月期间收治的肺癌患者116例，采用随机数字表法分为对照组和研究组，各58例。对照组患者给予传统开胸肺叶切除联合系统淋巴清扫治疗，研究组给予VATS联合系统淋巴清扫治疗，对比两组手术相关指标、血清疼痛相关因子和免疫功能，随访记录研究组患者5年生存率，分析预后的影响因素。结果：与对照组相比，研究组手术时间更长，术中出血量更少，术后住院时间、切口长度、引流时间更短（P<0.05）。两组术后1 d去甲肾上腺素（NE）、前列腺素E2（PGE2）、P物质（SP）、皮质醇（Cor）水平均较术前升高，但研究组低于对照组（P<0.05）。两组术后1 d CD3⁺、CD4⁺、CD4⁺/CD8⁺均较术前降低，但研究组高于对照组，CD8+较术前升高，但研究组低于对照组（P<0.05）。单因素分析结果可知：研究组患者的预后与组织分化、吸烟史、病灶直径、临床分期、清扫淋巴结个数有关（P<0.05）。多因素Logistic回归分析结果可知：临床分期、清扫淋巴结个数是研究组患者预后的影响因素（P<0.05）。结论：ATS联合系统淋巴清扫可减轻肺癌患者术后疼痛及免疫抑制，虽然手术时间更长，但可以改善其他围术期指标。此外，临床分期、清扫淋巴结个数是患者预后的影响因素，应引起临床重视。

Effect of Total Thoracoscopic Lobectomy Combined with Systemic Lymphadenectomy on Serum Pain Related Factors, Immune Function and Prognostic Factors in Patients with Lung Cancer

ABSTRACT Objective: To investigate the effect of total thoracoscopic lobectomy (VATS) combined with systemic lymph node dissection on serum pain related factors and immune function in patients with lung cancer, and to analyze the influencing factors of prognosis. Methods: 116 patients with lung cancer in our hospital from March 2014 to March 2016 were selected and randomly divided into control group and study group, 58 cases in each group. The control group was treated with traditional thoracotomy lobectomy combined with systemic lymphadenectomy, and the study group was treated with VATS combined with systemic lymphadenectomy. The perioperative related indexes, serum pain related factors and immune function of the two groups were compared. The 5-year survival rate of the study group was recorded and the influencing factors of prognosis were analyzed. Results: The operation time of the study group was longer than that of the control group, the incision length, postoperative hospital stay and drainage time were shorter than those of the control group, and the intraoperative blood loss was less than that of the control group (P<0.05). The levels of norepinephrine (NE), prostaglandin E2 (PGE2), substance P (SP) and cortisol (Cor) in the two groups increased 1 day after operation, and the levels of the study group were lower than those of the control group (P<0.05). The levels of CD3⁺, CD4⁺, CD4⁺/ CD8⁺ in the two groups 1d after operation were lower than those before operation, but the study group was higher than that in the control group, and CD8+ was higher than that before operation, but the study group was lower than that in the control group (P<0.05). Univariate analysis showed that the prognosis of patients in the study group was related to tissue differentiation, smoking history, lesion diameter, clinical stage, number of lymph nodes dissected(P<0.05). Multivariate Logistic regression analysis showed that clinical stage and number of lymph node dissection were the prognostic factors of patients in the study group(P<0.05). Conclusion: VATS combined with systemic lymphadenectomy can reduce postoperative pain and immunosuppression in patients with lung cancer. Although the operation time is longer, it can improve other perioperative indicators. In addition, the clinical stage and the number of lymph node dissection are independent factors affecting the prognosis of patients, which should be paid more attention.