To Analyze The Effect Of Video-assisted Thoracoscopic Surgery Preserving Pulmonary Branch On The Short-term Prognosis Of Patients With Lung Cancer And Its Risk Factors

Objective:To compare the safety and efficacy of video-assisted thoracoscopic lung cancer radical resection with or without preservation of the pulmonary branches of the vagus nerve.The short-term postoperative complications of the two groups were evaluated.The risk factors of postoperative complications were analyzed Methods:The intraoperative and postoperative data of lung cancer patients who underwent VATS in the Department of Thoracic Surgery,the First Affiliated Hospital of Nanchang University from July 2022 to January 2023 were prospectively collected.According to the different surgical methods received by the patients,they were divided into group A(pulmonary branch preservation of the vagus nerve group)and group B(non-pulmonary branch preservation of the vagus nerve group).Postoperative complications such as pulmonary infection and sinus tachycardia during hospitalization and cough at 2 and 4 weeks after surgery were observed by telephone follow-up.The LCQ-MC scale was used to compare the postoperative cough scores and univariate logistic regression was used to analyze the risk factors of postoperative cough and pulmonary infection.Results:Among 67 patients with lung cancer,there were 35 patients in the vagal nerve branch preservation group and 32 patients in the non-vagal nerve branch preservation group.There was no significant difference in clinical and pathological data between the two groups.In terms of postoperative complications,there was no significant difference between the two groups in postoperative catheterization time,postoperative white blood cell count,pulmonary infection,atelectasis,and postoperative sinus tachycardia.In terms of postoperative cough,32 cases(91.43%)had no cough and 3 cases(8.57%)had cough in group A;In group B,20 cases(62.50%)had no cough and 12 cases(37.50%)had cough.Group A vs.group B,P=0.005.The scores of LCQ-MC in group A were higher than those in group B at 2and 4 weeks after operation,and the difference was statistically significant at 2 weeks after operation(P<0.001).Univariate logistic regression analysis showed that preservation of the pulmonary branch of the vagus nerve(HR 0.748,95%CI,0.619-0.905;P=0.004)were the protective factors against the occurrence of CAP,while non-preservation of the pulmonary branch of the vagus nerve was a risk factor for the occurrence of CAP.Conclusions:For stageⅠ-Ⅲa NSCLC patients without lymphadenopathy on preoperative CT,the two surgical methods are safe and effective in terms of surgical technique and safety.Preservation of the pulmonary branch of the vagus nerve during VATS can reduce the incidence of postoperative CAP,while there is no significant difference in PA and pulmonary infection.