山东第二医科大学学报

目的 探讨单孔胸腔镜肺段切除术与肺叶切除术对老年肺癌患者术后免疫功能的影响。方法 选取2023年8月～2024年6月收治的80例老年肺癌患者，根据肿瘤特征和临床实践原则进行分组：观察组(40例)采用单孔胸腔镜肺段切除术；对照组(40例)采用单孔胸腔镜肺叶切除术。比较两组围手术期指标、免疫学指标、术后并发症及肺功能的变化。结果 观察组术中出血量、术后引流量、引流管留置时间、术后住院时间及术后1、3 d VAS评分均低于对照组(P<0.05)。术后1、3 d,两组患者IL-6、IL-17水平升高，IL-2水平降低，观察组变化程度小于对照组(P<0.05);CD3⁺、CD4⁺百分比及CD4⁺/CD8⁺比值下降，CD8⁺百分比升高，观察组变化程度亦小于对照组(P<0.05)。观察组术后并发症总发生率(12.5%)低于对照组(27.5%),两组比较，差异有统计学意义(P<0.05)。术后1个月，观察组肺功能指标下降程度小于对照组(P<0.05)。结论 单孔胸腔镜肺段切除术相比肺叶切除术，对老年肺癌患者创伤小，炎症反应轻，免疫功能抑制程度低，肺功能保留好，并发症发生率低，可作为早期老年肺癌患者的首选术式。

Objective To investigate the effects of single-port thoracoscopic segmentectomy versus lobectomy on postoperative immune function in elderly lung cancer patients.Methods Eighty elderly lung cancer patients admitted from August 2023 to June 2024 were grouped according to tumor characteristics and clinical practice principles: observation group(40 cases) underwent single-port thoracoscopic segmentectomy; control group(40 cases) underwent single-port thoracoscopic lobectomy.Perioperative indicators, immunological parameters, postoperative complications, and changes in pulmonary function were compared between the two groups.Results The observation group had less intraoperative blood loss, postoperative drainage volume, shorter drainage tube retention time, shorter postoperative hospital stay, and lower VAS scores on days 1 and 3 after surgery compared with the control group(P<0.05).On days 1 and 3 after surgery, IL-6 and IL-17 levels increased while IL-2 levels decreased in both groups, but changes were less pronounced in the observation group(P<0.05).The percentages of CD3⁺ and CD4⁺ and CD4⁺/CD8⁺ ratio decreased while CD8⁺ percentage increased, with the observation group showing less alteration(P<0.05).The total incidence of postoperative complications in the observation group(12.5%) was lower than in the control group(27.5%)(P<0.05).At 1 month after surgery, the decline in pulmonary function parameters was less in the observation group than in the control group(P<0.05).Conclusion A Comparison of Single-Port Segmentectomy and Lobectomy, Single-port thoracoscopic segmentectomy causes less trauma, milder inflammatory response, lower immune function suppression, better preservation of pulmonary function, and lower incidence of complications in elderly lung cancer patients, making it the preferred surgical approach for early-stage elderly lung cancer.