不同食管癌根治术对患者术后肺功能及炎性因子水平的影响

Impacts of different esophageal carcinoma radical resection surgeries on postoperative lung function and inflammatory factors

目的探讨食管癌患者采用胸腔镜辅助小切口食管癌切除术与传统开胸食管胃胸内吻合术对患者术后肺功能及炎性因子的影响。方法回顾性分析69例食管癌根治术患者病历资料,根据手术方法的不同分为胸腔镜组34例和开胸组35例,胸腔镜组患者实施胸腔镜辅助小切口食管癌切除术,开胸组患者经左后外侧开胸行传统的食管胃胸内吻合术治疗,于术后1个月测定两组患者肺功能,于术后1、3、5d测定两组患者外周血炎性因子表达水平。结果术后1个月,胸腔镜组患者术后肺功能指标均高于开胸组,其中肺活量占预计值百分比分别为(80.48±8.68)%、(75.25±7.33)%,用力呼气量占预计值的百分比分别为(78.20±7.35)%、(74.56±6.97)%,差异有统计学意义(t1=2.070,P=0.042;t2=2.111,P=0.039)。胸腔镜组肿瘤坏死因子-α(TNF-α)术后1、3、5d分别为(2.80±0.72)、(2.09±0.66)、(1.23±0.68)ng/mL,均明显低于开胸组患者(3.50±0.70)、(2.57±0.76)、(1.66±0.70)ng/mL,差异有统计学意义(P<0.05)。胸腔镜组IL-6、IL-10术后1、3d均明显低于开胸组,差异有统计学意义(P<0.05),两组不同时点IL-8差异均无统计学意义(P>0.05)。结论两种食管癌根治后患者肺功能均不同程度下降,胸腔镜辅助小切口食管癌根治术式对患者肺功能的影响小于传统开胸食管胃胸内吻合术式,且腔镜手术在降低术后炎性反应方面较传统开胸手术更具优势。

Objective To investigate the impacts of thoracoscopy-assisted mini-incision esophageal carcinoma resection（TAMIECR）and traditional open chest esophageal intrathoracic stomach anastomosis（OCEISA）on patients′postoperative lung function and inflammatory factors.Methods A retrospective study was conducted on the medical record data in 69 esophageal carcinoma patients underwent radical resection,among them,34 cases underwent TAMIECR operation,while the other 35 cases underwent OCEISA operation.The lung function at postoperative 1month were examined in 2groups,and the peripheral inflammation factors levels groups on postoperative 1,3,5d were determined.Results The lung function indexes at postoperative 1 month in the thoracoscope group were all higher than those in the thoracotomy group,in which VC% was（80.48±8.68）% and（75.25±7.33）%respectively,FVC% was（78.20±7.35）% and（74.56±6.97）%respectively,the differences were statistically significant（t1=2.070,P=0.042;t2=2.111,P=0.039）.The TNF-αlevel on postoperative 1,3,5din the thoracoscope group was（2.80±0.72）,（2.09±0.66）and（1.23±0.68）ng/mL respectively,which were significantly lower than（3.50±0.70）,（2.57±0.76）and（1.66±0.70）ng/mL in the thoracotomy group,the differences were statistically significant（P〈0.05）;the IL-6and IL-10 levels on postoperative 1,3din the thoracoscope group were significantly lower than those in the thoracotomy group with statistical differences（P〈0.05）,while the IL-8level at different time points had no statistical differences between the two groups（P〉0.05）.Conclusion The patients′lung function after two kinds of esophageal cancer radical resection operation is decreased to different degrees,the influence of TAMIECR operation mode on the lung function is smaller than that of the OCEISA operation mode,moreover the laparoscopic operation has more superiority in the aspect of reducing postoperative inflammatory reaction than the traditional OCEISA operation mode.