新疆医科大学学报

目的 探讨胸腔镜下单孔与多孔肺段切除术对早期非小细胞肺癌(Non-small cell lung cancer, NSCLC)患者代谢反应及心肺耐力的影响。方法 选取2017年6月-2022年10月南通市第一人民医院早期NSCLC患者92例，根据简单随机数字表法分为多孔组与单孔组，各46例。单孔组采取胸腔镜单孔肺段切除术，多孔组采取胸腔镜多孔肺段切除术。比较两组围术期情况、术前及术后3 d代谢反应指标[视黄醇结合蛋白(Retinol-binding protein, RBP)、转铁蛋白(Transferrin, TRF)、前白蛋白(Prealbumin, PA)]水平、心肺耐力[6 min步行距离(6 min walking distance, 6MWT)、疲劳指数、呼气峰流速(Peak expiratory velocity, PEF)、第1 s用力呼气容积(Forced expiratory volume 1 s, FEV1)]和并发症发生率。结果 (1)两组手术时长、淋巴结清扫数目比较，差异无统计学意义(P>0.05),单孔组术中失血量、引流量少于多孔组，引流管放置时间、住院时长短于多孔组，差异有统计学意义(P<0.05)。(2)术后3 d两组PA、TRF、RBP水平较术前下降，但单孔组PA、TRF、RBP水平高于多孔组，差异有统计学意义(P<0.05)。(3)术后3 d两组6MWT、PEF、FEV1较术前降低，疲劳指数较术前增高，但单孔组6MWT、PEF、FEV1高于多孔组，疲劳指数低于多孔组，差异有统计学意义(P<0.05)。(4)单孔组并发症发生率(4.35%)低于多孔组(17.39%),差异有统计学意义(P<0.05)。结论 采取胸腔镜单孔及多孔肺段切除术治疗早期NSCLC均可取得良好效果，但单孔术式可减少失血量，对代谢状态及心肺耐力影响较小，利于机体功能及早康复，且可降低并发症发生风险。

Objective To investigate the effects of thoracoscopic single-hole and multi-hole segmental pneumonectomy on metabolic response and cardiopulmonary tolerance in patients with early non-small cell lung cancer(NSCLC). Methods 92 patients with early NSCLC in the hospital from June 2017 to October 2022 were selected and divided into porous group and single pore group according to simple random number table, with 46 patients in each group. Thoracoscopic single-hole segmental pneumonectomy was performed in the single-hole group, and thoracoscopic multi-hole segmental pneumonectomy was performed in the multi-hole group. The perioperative conditions, preoperative and postoperative 3 d metabolic response indexes(retinol-binding protein(RBP), transferrin(TRF), prealbumin(PA) and cardiorespiratory endurance of 2 groups were analyzed 6 min walking distance(6MWT), fatigue index, peak expiratory flow rate(PEF), forced expiratory volume in the first second(FEV1) and complication rate. Results(1) There were no statistically significant differences in operation duration and number of lymph node dissection between the 2 groups(P>0.05). The intraoperative blood loss and drainage volume in the single-hole group was less than those in the porous group, and the placement time of drainage tube and length of hospitalization were significantly different than those in the porous group(P<0.05).(2) The levels of PA, TRF and RBP in the 2 groups were lower than those before surgery 3 days after operation, but the levels of PA, TRF and RBP in the single-hole group were higher than those in the multi-hole group, and the difference was statistically significant(P<0.05).(3) At 3 days after operation, 6MWT, PEF and FEV1 in both groups were lower than before operation, and fatigue index was higher than before operation, but 6MWT, PEF and FEV1 in the single-well group were higher than those in the multi-hole group, and fatigue index was lower than those in the multi-hole group, with statistical significance(P<0.05).(4) The incidence of complications in the single-pore group(4.35%) was lower than that in the multi-pore group(17.39%), and the difference was statistically significant(P<0.05). Conclusion Thoracoscopic single-hole and multi-hole segmental pneumonectomy can achieve good results in the treatment of early NSCLC, but single-hole surgery can reduce blood loss, have little impact on metabolic status and cardiopulmonary endurance, facilitate the early recovery of body function, and reduce the risk of complications.