3D-CTBA精准定位应用于胸腔镜肺段切除术患者的临床价值

doi:10.3760/cma.j.issn.1007-1245.2024.06.008

摘要/Abstract

摘要：

目的　探讨三维计算机断层扫描支气管血管成像（3D-CTBA）精准定位对胸腔镜肺段切除术患者糖类抗原125（CA125）、CA724、癌胚抗原（CEA）及肺功能的改善效果。方法　前瞻性选取2019年8月至2022年8月安阳市中医院收治的135例行胸腔镜肺段切除术的早期非小细胞肺癌（NSCLC）患者，以随机数字表法分为对照组（67例）和研究组（68例）。对照组中男性42例，女性25例，年龄（58.75±6.81）岁，肿瘤长径（1.39±0.25）cm；研究组患者中男性41例，女性27例，年龄（58.22±6.35）岁，肿瘤长径（1.36±0.31）cm。对照组患者行胸腔镜肺段切除术；研究组患者在胸腔镜肺段切除术前行3D-CTBA精准定位。对比两组患者手术相关指标，术前、术后7 d血清肿瘤标志物水平，术前、术后1个月肺功能指标的变化，两组患者并发症发生情况。采用χ²检验和独立样本t检验。结果　研究组患者手术时间［（115.77±7.96）min］、胸腔引流管拔除时间［（3.48±0.81）d］均短于对照组［（140.05±8.77）min、（4.52±0.74）d］，术中出血量、术后引流量均比对照组少［（129.83±11.65）ml比（150.02±10.23）ml、（541.23±41.78）ml比（720.22±56.66）ml］，淋巴结清扫个数比对照组多［（11.86±2.44）个比（9.26±2.31）个］（均P<0.05）；术后7 d，两组患者血清CA125、CA724、CEA水平均较术前下降，且研究组［（29.88±6.15）U/ml、（11.75±7.08）U/ml、（15.55±5.67）µg/L］均低于对照组［（36.78±5.42）U/ml、（18.35±6.24）U/ml、（21.22±6.45）µg/L］（均P<0.05）；术后1个月，两组患者用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、最大呼气峰值流速（PEF）均较术前下降，但研究组［（2.95±0.58）L、（1.68±0.19）L、（4.73±0.59）L/s］均高于对照组［（2.72±0.65）L、（1.50±0.33）L、（4.50±0.57）L/s］（均P<0.05）。研究组患者的并发症总发生率为10.29%（7/68），低于对照组的29.85%（20/67），差异有统计学意义（χ²=8.067，P=0.005）。结论　3D-CTBA精准定位应用于早期NSCLC胸腔镜肺段切除术患者中，可降低血清肿瘤标志物水平，减少对肺功能的影响，且并发症少，手术安全性高。

关键词:

非小细胞肺癌, 胸腔镜肺段切除术, 三维计算机断层扫描支气管血管成像, 糖类抗原125, 糖类抗原724, 癌胚抗原, 肺功能, 改善

Abstract:

Objective　To investigate the effect of three-dimensional computed tomography bronchography and angiography (3D-CTBA) precise localization on the improvement of carbohydrate antigen 125 (CA125), carbohydrate antigen 724 (CA724), carcinoembryonic antigen (CEA), and lung function in patients with thoracoscopic segmentectomy. Methods　A total of 135 patients with early non-small cell lung cancer (NSCLC) who underwent thoracoscopic segmentectomy in Anyang Hospital of Traditional Chinese Medicine from August 2019 to August 2022 were prospectively selected and were divided into a control group (67 cases) and a study group (68 cases) by the random number table method. In the control group, there were 42 males and 25 females, aged (58.75±6.81) years, with a tumor diameter of (1.39±0.25) cm; in the study group, there were 41 males and 27 females, aged (58.22±6.35) years, with a tumor diameter of (1.36±0.31) cm. The control group underwent thoracoscopic segmentectomy, while the study group underwent 3D-CTBA precise localization before thoracoscopic segmentectomy. The operation-related indexes, serum tumor marker levels before and 7 days after surgery, changes in pulmonary function indexes before and 1 month after surgery, and incidence of complications were compared between the two groups. χ² test and independent sample t test were used. Results　The operation time and thoracic drainage tube removal time [(115.77±7.96) min and (3.48±0.81) d] in the study group were shorter than those in the control group [(140.05±8.77) min and (4.52±0.74) d], the intraoperative blood loss and postoperative drainage volume were less than those in the control group [(129.83±11.65) ml vs. (150.02±10.23) ml, (541.23±41.78) ml vs. (720.22±56.66) ml], and the number of lymph nodes dissected was more than that in the control group [(11.86±2.44) vs. (9.26±2.31)] (all P<0.05). Seven days after surgery, the levels of CA125, CA724, and CEA in both groups were decreased compared with those before surgery, and those in the study group [(29.88±6.15) U/ml, (11.75±7.08) U/ml, and (15.55±5.67) µg/L] were lower than those in the control group [(36.78±5.42) U/ml, (18.35±6.24) U/ml, and (21.22±6.45) µg/L] (all P<0.05). One month after surgery, the forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), and peak expiratory flow (PEF) in both groups were decreased compared with those before surgery, and those in the study group [(2.95±0.58) L, (1.68±0.19) L, and (4.73±0.59) L/s] were higher than those in the control group [(2.72±0.65) L, (1.50±0.33) L, and (4.50±0.57) L/s] (all P<0.05). The total incidence of complications in the study group was 10.29% (7/68), which was lower than that in the control group [29.85% (20/67)], with a statistically significant difference (χ²=8.067, P=0.005). Conclusion　The precise positioning of 3D-CTBA in patients undergoing thoracoscopic segmentectomy for early NSCLC can reduce the levels of serum tumor markers, reduce the impact on lung function, and have fewer complications and high surgical safety.

Key words:

Non-small cell lung cancer, Thoracoscopic segmentectomy, Three-dimensional computed tomography bronchography and angiography, Carbohydrate antigen 125, Carbohydrate antigen 724, Carcinoembryonic antigen, Lung function, Improvement

张前陈亮杨冉.

3D-CTBA精准定位应用于胸腔镜肺段切除术患者的临床价值 [J]. 国际医药卫生导报, 2024, 30(6): 923-927.

Zhang Qian, Chen Liang, Yang Ran.

Clinical value of 3D-CTBA precise localization in patients undergoing thoracoscopic segmentectomy for early NSCLC [J]. International Medicine and Health Guidance News, 2024, 30(6): 923-927.

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