目的 探讨虚拟导航支气管镜（VBN）辅助定位在胸腔镜下肺叶部分切除和楔形切除术中的应用效果，并分析其对创伤应激指标的影响。 方法 选取2022年1月至2024年12月我院收治的322例接受胸腔镜下肺叶部分切除术或楔形切除术的早期非小细胞肺癌（NSCLC）患者。根据辅助定位方式分为VBN组（n=158）和对照组（n=164）。对照组应用CT引导下注射染色标记物定位，VBN组应用VBN辅助定位。比较两组患者手术相关指标、应激指标、炎症因子、肺功能、血气分析指标以及手术并发症。结果 VBN组手术时间、术中出血量、胸腔引流量、胸腔引流天数、术后住院时间低于对照组（P<0.05）。VBN组术后血清皮质醇（Cor）、去甲肾上腺素（NE）水平以及手术应激指数（SSI）低于对照组（P<0.05）。VBN组术后血清白细胞介素-6（IL-6）、C反应蛋白（CRP）、嗜酸性细胞阳离子蛋白（ECP）水平低于对照组（P<0.05）。VBN组术后呼气峰流速（PEF）、第一秒用力呼气量占肺活量比值（FEV1%）、每千克体重潮气量（TV）、吸气与呼气时间比值（Ti/Te）、达峰时间比（TPTEF/TE）、达峰容积比（VPEF/VE）高于对照组（P<0.05）。VBN组术后PaO2、SaO2高于对照组，PaCO2低于对照组（P<0.05）。VBN组手术总并发症发生率（3.80%）低于对照组（9.76%，P<0.05）。 结论 在胸腔镜下肺叶部分切除和楔形切除术中应用VBN辅助定位可明显缩短手术时间，减轻术中创伤、应激以及炎症反应，改善呼吸功能，减少并发症，促进患者更快恢复。
Abstract
Objective To investigate the application effects of virtual bronchoscopic navigation (VBN) in thoracoscopic partial lobectomy and wedge resection, and analyze the impact on traumatic stress indicators. Methods A total of 322 patients with early-stage non-small cell lung cancer (NSCLC) who underwent thoracoscopic partial lobectomy or wedge resection at the hospital from January 2022 to December 2024 were selected. Based on the localization method, patients were divided into a VBN group (n=158) and a control group (n=164). The control group received CT-guided dye marker injection for localization, while the VBN group received VBN-assisted localization. Surgery-related indicators, stress indicators, inflammatory factors, pulmonary function, blood gas analysis indicators, and surgical complications were compared between the two groups. Results Compared with the control group, the VBN group showed reductions in the duration of surgery, intraoperative blood loss, thoracic drainage volume, thoracic drainage days, and postoperative hospital stay (P<0.05). Postoperative serum cortisol (Cor) and norepinephrine (NE) levels, and surgical stress index (SSI) in the VBN group were lower than those in the control group (P<0.05). The VBN group exhibited lower postoperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and eosinophil cationic protein (ECP) compared with the control group (P<0.05). The VBN group demonstrated higher postoperative peak expiratory flow (PEF), forced expiratory volume in one second to vital capacity ratio (FEV1%), tidal volume (TV) per kilogram, inspiratory-to-expiratory time (Ti/Te) ratio, time to peak tidal expiratory flow to expiratory time ratio (TPTEF/TE), and volume to peak expiratory flow to total expiratory volume ratio (VPEF/VE) than the control group (P<0.05). After surgery, the VBN group had higher PaO2 and SaO2 and lower PaCO2 compared with the control group (P<0.05). The total complication rate in the VBN group (3.80%) was lower than that in the control group (9.76%) (P<0.05). Conclusion Using VBN in thoracoscopic partial lobectomy and wedge resection can significantly shorten operation time, reduce intraoperative trauma, stress and inflammatory response, improve respiratory function, reduce complications, and promote recovery.
关键词
虚拟导航支气管镜 /
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肺叶部分切除术 /
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肺楔形切除术 /
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创伤 /
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应激
Key words
Virtual bronchoscopic navigation /
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Partial lobectomy /
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Wedge resection /
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Trauma /
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Stress
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