标题：胸腔镜下肺段切除术对老年肺磨玻璃结节患者氧化应激、肺功能及预后的影响

      作者：吕峰，康树宏    中国人民解放军空军军医大学第二附属医院胸腔外科，陕西 西安 710004

      卷次： 2021年32卷4期

      【摘要】 目的 探究胸腔镜下肺段切除术对老年肺磨玻璃结节患者氧化应激、肺功能及预后的影响。方法 选取 2016年 1~12月于中国人民解放军空军军医大学第二附属医院治疗的 96例老年肺磨玻璃结节患者为研究对象，采用随机数表法将患者分为对照组和观察组，每组48例。对照组给予胸腔镜下肺叶切除术治疗，观察组在胸腔镜下行肺段切除术治疗。比较两组患者的手术总有效率及手术时间、术中出血量、住院时间、术后留置引流管时间；比较两组患者手术前后肺功能激指标[最大肺活量(FVC)、最大每分钟通气量(MVV)、残气量(RV)]及血清氧化应激指标[还原型烟酰胺腺嘌呤二核苷酸磷酸氧化酶2 (NOX2)、还原型烟酰胺腺嘌呤二核苷酸磷酸氧化酶4(NOX4)]；统计并比较两组患者3年生存率、死亡率、复发率、远处转移率以及术后并发症发生情况。结果 观察组患者的手术总有效率为95.83%，明显高于对照组的81.25%，术后并发症总发生率为2.08%，明显低于对照组的14.58%，差异均有统计学意义(P<0.05)；观察组患者的手术时间为(169.15±18.69) min，明显长于对照组的(152.39±16.07) min，住院时间及术后留置引流管时间分别为(15.81±1.73) d、(3.93±0.51) d，明显短于对照组的(16.93±1.85) d、(4.27±0.64) d，术中出血量为(35.42±5.96) mL，明显少于对照组的(49.66±7.14) mL，差异均有统计学意义(P<0.05)；观察组患者术后 1周的 FVC、MVV值分别为(3.12±0.39) L、(98.24±12.71) L/min，明显大于对照组的(2.87±0.34) L、(90.39±10.06) L/min，RV值为(4.87±0.75) L，明显小于对照组的(2.87±0.34) L，差异均有统计学意义(P<0.05)；观察组患者术后NOX2、NOX4分别为(0.43±0.06) β-action、(0.31±0.05) β-action，明显小于对照组的(0.47±0.07) β-action、(0.34±0.07) β-action，差异均有统计学意义(P<0.05)；两组患者的3年生存率、死亡率、复发率及远处转移率比较差异均无统计学意义(P>0.05)。结论 应用胸腔镜下肺段切除术治疗老年肺磨玻璃结节的有效率较高，可缩短患者住院时间及术后留置引流管时间，减轻氧化应激反应，改善肺功能，且术后并发症少。
      【关键词】 胸腔镜；肺段切除术；肺磨玻璃结节；老年患者；氧化应激反应；肺功能；预后
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2021）04—0460—05

Effects of thoracoscopic lung segmentectomy on oxidative stress, lung function, and prognosis in elderly patientswith lung ground-glass nodules.
LV Feng, KANG Shu-hong. Department of Thoracic Surgery, the Second AffiliatedHospital of Air Force Medical University of PLA, Xi'an 710004, Shaanxi, CHINA
【Abstract】 Objective To explore the effects of thoracoscopic lung segmentectomy on oxidative stress, lungfunction, and prognosis in elderly patients with lung ground-glass nodules (GGN). Methods A total of 96 elderly pa-tients with lung GGN who were treated in the Second Affiliated Hospital of Air Force Medical University of PLA fromJanuary 2016 to December 2016 were enrolled as the research objects. They were divided into a control group and an ob-servation group by random number table method, with 48 cases in each group. The control group underwent thoracoscop-ic lung lobectomy, while the observation group underwent thoracoscopic lung segmentectomy. The total response rate ofsurgery, operation time, intraoperative blood loss, hospitalization time, postoperative indwelling time of drainage tube,lung function stress indexes (forced vital capacity [FVC], maximal voluntary ventilation [MVV], residual volume [RV]),and serum oxidative stress indexes (reduced nicotinamide adenine dinucleotide phosphate oxidase 2 [NOX2], reducednicotinamide adenine dinucleotide phosphate oxidase [NOX4]) before and after surgery were compared between the twogroups. The 3-year survival rate, mortality, recurrence rate, distant metastasis rate, and occurrence of postoperative com-plications were statistically analyzed and compared between the two groups. Results The total response rate of sur-gery in observation group was significantly higher than that in control group (95.83% vs 81.25%), while the total inci-dence of postoperative complications was significantly lower than that in control group (2.08% vs 14.58%, P<0.05). Theoperation time in observation group was longer than that in control group: (169.15±18.69) min vs (152.39±16.07) min;the hospitalization time and postoperative indwelling time of drainage tube were shorter than those in control group:(15.81±1.73) d vs (16.93±1.85) d, (3.93±0.51) d vs (4.27±0.64) d); the intraoperative blood loss was less than that incontrol group: (35.42±5.96) mL vs (49.66±7.14) mL; the differences were statistically significant (P<0.05). At 1 weekafter surgery, FVC and MVV in the observation group were greater than those in control group: (3.12±0.39) L vs (2.87±