对比微创食管癌切除术与传统食管胃胸内吻合术对食管癌患者肺功能及炎症细胞因子的影响

Comparison of changes of lung function and inflammatory cytokines between minimally invasive esophagectomy and traditional intrathoracic esophagogastric anastomosis in the treatment of esophageal carcinoma

目的研究微创食管癌切除术与传统食管胃胸内吻合术对食管癌患者肺功能、炎症细胞因子的影响。方法选取65例食管癌患者,随机分为两组,微创组(33例)采用单纯腹腔镜、腹腔镜与胸腔镜联合治疗的微创食管癌切除术,传统组(32例)采用食管胃胸内吻合术,观测两组患者手术情况、并发症、术前术后肺功能(FEV、VC、FVC、MVV、FEV1)、膈肌浮动度(mm)及炎症细胞因子(IL-6、IL-8、IL-10、TNF-α)变化。结果微创组与传统组开胸时间、手术时间分别为(2.00±1.22)h vs(3.34±0.94)h、(4.51±1.17)h vs(3.34±0.94)h,差异有统计学意义(P<0.05);两组术后并发症比较,差异无统计学意义(P>0.05);术后微创组肺功能各项指标高于对照组,差异有统计学意义(P<0.05);术后除IL-8浓度变化无差异,其余各项指标差异均有统计学意义(P<0.05)。结论微创手术和传统手术均会对食管癌患者肺功能造成一定的影响,且炎症细胞因子术后会出现相应的变化。但相对于传统手术,微创手术对肺功能的影响更小,且在降低炎症反应上更具有优势。

Objective To investigate the effect of hmg function and inflammatory cytokines between minimally inva- sive esophagectomy and traditional intrathoracic esophagogastric anastomosis in the treatment of esophageal carcinoma. Methods Sixty-five patients with esophageal cancer were randomly divided into the minimally invasive group （33 ca- ses） treated by minimally invasive esophagectomy with single laparoseope or laparoscopic combined thoracoseopic, the traditional group（32 cases） treated by intrathoracic esophagogastric anastomosis. The operation, pulmonary function in preoperative and postoperative, the incidence of complications, the floating of diaphragm, and the levels of inflammatory cytokines （IL-6, IL-8, IL-10, TNF-α） were compared between two groups. Results The open chest time and operation time of minimally invasive group and traditional group were （2.00 ± 1.22） vs （3.34 ±0.94）h, （4.51 ± 1. 17） vs （3.34 ±0.94） h, the difference had statistical significance （P 〈 0.05 ）. The difference of postoperative complications between two groups had no statistical significance （ P 〉 0.05 ）. The indicators of pulmonary function in the minimally in- vasive group were higher than those in the traditional group （P 〈0. 05）. After the operation, most indicators between two groups had statistical difference （P 〈0. 05） , except IL-8. Conclusion Both the minimally invasive operation and traditional operation have obvious influences on the pulmonary function, and the inflammatory cytokines also had some corresponding changes. Compared with the traditional operation, the minimally invasive surgery has more advantages a- bout the influence on the changes of lung function and inflammatory cytokines.