CAJ | 학술논문

背景与目的电视辅助胸腔镜手术（video-assisted thoracoscopic surgery, VATS）是胸部微创手术的代表，相对于传统开胸手术（traditional open surgery, TOS），VATS具有创伤小、疼痛轻、恢复快等优势。本研究旨在比较VATS与传统开胸肺叶切除治疗非小细胞肺癌（non-small cell lung cancer, NSCLC）围手术期甲状腺激素水平的变化。方法选取卫生部北京医院胸外科2010年10月-2012年8月收治的NSCLC患者44例，根据手术方式的不同分为：胸腔镜组（VATS组，25例）及传统开胸组（TOS组，19例）。两组于手术前1天、术后第1天、2天、3天、7天分别测定游离T3（free T3, FT3）、游离T4（free T4, FT4）、反T3（reverse T3, rT3）、促甲状腺激素（thyroid stimulating hor-mone, TSH）的水平，观察两组术后各指标的变化规律，比较两组间变化的差异。结果术前患者甲状腺激素水平均在正常值范围内，两组比较无统计学差异（P>0.05）。FT3及TSH术后均表现为先降低后升高，分别于术后第3天、术后第1天达到最低水平，术后第7天时VATS组已恢复至术前水平，但TOS组FT3仍明显低于术前（P=0.032）；FT4及rT3术后均表现为先升高后降低，均于术后第2天达到峰值，TOS组术后第1天、2天、3天rT3水平均明显高于VATS组（P<0.05）。术后FT3降低及rT3升高均超出正常值范围，而FT4及TSH变化均在正常值范围内。两组间各指标变化趋势比较，rT3变化有统计学差异（F=7.557, P=0.009）。结论 NSCLC患者行肺叶切除术后均出现正常甲状腺功能病态综合征，相对于传统开胸手术，胸腔镜手术对机体甲状腺激素水平影响小，机体应激反应小，利于肺癌患者术后恢复。
배경여목적전시보조흉강경수술（video-assisted thoracoscopic surgery, VATS）시흉부미창수술적대표，상대우전통개흉수술（traditional open surgery, TOS），VATS구유창상소、동통경、회복쾌등우세。본연구지재비교VATS여전통개흉폐협절제치료비소세포폐암（non-small cell lung cancer, NSCLC）위수술기갑상선격소수평적변화。방법선취위생부북경의원흉외과2010년10월-2012년8월수치적NSCLC환자44례，근거수술방식적불동분위：흉강경조（VATS조，25례）급전통개흉조（TOS조，19례）。량조우수술전1천、술후제1천、2천、3천、7천분별측정유리T3（free T3, FT3）、유리T4（free T4, FT4）、반T3（reverse T3, rT3）、촉갑상선격소（thyroid stimulating hor-mone, TSH）적수평，관찰량조술후각지표적변화규률，비교량조간변화적차이。결과술전환자갑상선격소수평균재정상치범위내，량조비교무통계학차이（P>0.05）。FT3급TSH술후균표현위선강저후승고，분별우술후제3천、술후제1천체도최저수평，술후제7천시VATS조이회복지술전수평，단TOS조FT3잉명현저우술전（P=0.032）；FT4급rT3술후균표현위선승고후강저，균우술후제2천체도봉치，TOS조술후제1천、2천、3천rT3수평균명현고우VATS조（P<0.05）。술후FT3강저급rT3승고균초출정상치범위，이FT4급TSH변화균재정상치범위내。량조간각지표변화추세비교，rT3변화유통계학차이（F=7.557, P=0.009）。결론 NSCLC환자행폐협절제술후균출현정상갑상선공능병태종합정，상대우전통개흉수술，흉강경수술대궤체갑상선격소수평영향소，궤체응격반응소，리우폐암환자술후회복。
Background and objective Video-assisted thoracoscopic surgery (VATS) is the representative thoracic minimally invasive surgery. Compared with traditional open surgery (TOS), VATS has an advantage of less invasiveness, quicker recovery and milder postoperative pain. The aim of this study is to compare the influences of VATS and conventional thoracotomic lobectomy on thyroid hormones in treatment for non-small cell lung cancer (NSCLC). Method From Oct. 2010 to Aug. 2012, 44 consecutive patients with NSCLC were recruited and divided into two groups: VATS group (25 patients) and TOS group (19 patients). All the patients were drawn blood to measure the plasma levels of free T3, free T4, reverse T3 and TSH on the morning of the day before surgery, the postoperative day (POD)1, POD2, POD3 and POD7. We described the perioperative variation trend of the thyroid hormones and compared the differences between VATS group and TOS group. Results There were no differences of thyroid hormone levels between the two groups before surgery. After surgery, the levels of FT3 and TSH were first dropped, then elevated and reached the lowest level on POD3 and POD1 separately. On POD7, they regained the before-surgery levels in VATS group while FT3 level was still significantly lower in TOS group (P=0.032). The FT4 and rT3 levels were first elevated, and then dropped after surgery. They both reached the peak concentrations on POD2, and rT3 levels of TOS group were significantly higher than those of VATS group on POD1, POD2 and POD3 (P<0.05). The changes of FT3 and rT3 levels were beyond normal ranges while changes of FT4 and TSH levels were within normal ranges.When variation trend of all the thyroid hormones were compared between the two groups, only rT3 level was found to have significant statistical differences (F=7.557, P=0.009). Conclusion All NSCLC patients after lobectomy have Euthyroid sick syndrome (ESS). Compared with traditional thoracotomy, VATS surgery has smaller influence on perioperative thyroid hormones and demonstrates a weaker acute stress reaction, which can benefit postoperative recovery of NSCLC patients.