胸腹腔镜食管癌根治术与开放食管癌根治术对患者肺功能、免疫功能及应激反应的影响

Effects of minimally invasive esophagectomy vs. traditional open esophagectomy of esophageal carcinoma on the lung function, immune function and stress response

目的观察胸腹腔镜微创手术与传统开胸手术对食管癌患者肺功能、免疫功能及应激反应的影响。方法选取我院收治的食管癌患者70例，根据治疗方法不同分为实验组（n＝37）和对照组（n＝33）。实验组行胸腹腔镜微创食管癌根治术，对照组行传统开放食管癌根治术。比较两组术后1个月肺功能指标[肺活量占预计值百分比（VC%）、用力呼气量占预计值百分比（FEV%）、第1秒用力呼气量占预计值百分比（FEV1%）、用力肺活量占预计值百分比（FVC%）、每分钟最大通气量占预计值百分比（MVV%）]及术后1、5 d免疫功能[肿瘤坏死因子-α（TNF-α）；白细胞介素-6（IL-6）]、应激反应指标[白细胞计数（WBC）、C反应蛋白（CRP）、皮质醇]水平变化。 结果 实验组手术时间为（240.86±13.96） min、出血量为（204.84±12.47） ml、住院时间为（10.62±1.42） d，均低于对照组，且差异有统计学意义（t＝－3.318、－6.739、－6.763，P＝0.000、0.000、0.001）。实验组患者术后1个月肺功能VC、FEV、FEV1、FVC水平分别为（81.8±4.5）%、（79.1±4.6）%、（76.0±6.2）%、（79.4±5.7）%，均较对照组高，差异有统计学意义（t＝3.857、6.231、3.608、3.302，P＝0.000、0.000、0.001、0.003）。实验组患者术后1、5 d的TNF-α水平分别为（3.02±0.47）、（1.35±0.31） mg/ml，均明显低于对照组（t＝－3.251、－4.542，P＝0.002、0.000）；实验组患者术后1 d的IL-6水平为（216.51±49.19） pg/ml，低于对照组（t＝－2.251，P＝0.028）。实验组术后第1、5天的WBC、CRP水平分别为（12.16±2.00）×109/L、（10.42±1.75）×109/L；（93.71±18.74）、（23.84±12.09） mg/L，与对照组比较差异均无统计学意义（t＝－1.930、－0.278，P＝0.058、0.782；t＝－1.841、－0.717，P＝0.070、0.476）；实验组术后第1天皮质醇水平为（862.60±195.83） nmol/L，与对照组比较差异有统计学意义（t＝－2.148，P＝0.035）。 结论与传统开胸手术比较，胸腹腔镜微创手术能有效减少手术创伤和炎性因子的释放，对患者肺功能影响更小，有利于改善患者预后，但对机体应激反应无明显影响。

ObjectiveTo investigate the effect of minimally invasive esophagectomy （MIE） vs. traditional open esophagectomy on pulmonary function, immune function and stress response in patients with esophageal cancer. MethodsSeventy patients with esophageal cancer were randomly divided into the experimental group （37 cases） and control group （33 cases） according to the different treatment methods. The experimental group received minimally invasive laparoscopic surgery, and the control group underwent traditional open surgery. The pulmonary function indexes of the two groups were measured at 1st month after surgery. The immune function and stress response indexes were compared at first and 5th day after surgery. ResultsThere were significant differences in the operation time [（240.86±13.96） vs. （251.15±11.70） min], bleeding volume [（204.84±12.47） vs. （229.69±18.15） ml] and hospital stay [（10.62±1.42） vs. （13.00±1.52） days] between the experimental group and the control group （t=-3.318, -6.739, -6.763, P=0.000, 0.000, 0.001）. The VC, FEV, FEV1 and FVC in the minimally invasive group were higher than those in the traditional group （t=3.857, 6.231, 3.608, 3.302, P=0.000, 0.000, 0.001, 0.003）. The levels of TNF-α in the experimental group were （3.02±0.47） and （1.35±0.31） mg/ml respectively, which were significantly lower than those in the control group at 1st and 5th day after surgery （t=-3.251, -4.542, P=0.002, 0.000）. The level of interleukin （IL）-6 in the experimental group was （216.51±49.19） pg/ml at 1st day after operation, which was lower than that in the control group （t=-2.251, P=0.028）. The counts of white blood cells （WBC） and C-reactive protein （CRP） levels in the experimental group at 1st and 5th day after surgery were （12.16±2.00）×109/L and （10.42±1.75）×109/L, and （93.71±18.74） and （23.84±12.09） mg/L respectively. There was no significant difference between the two groups （t=-1.930, -0.278, P=0.058, 0.782; t=-1.841, -0.717, P=0.070, 0.476）. The level of cortisol at 1st day after surgery was （862.60±195.83） nmol/L, which was statistically significantly different from that in the control group （t=-2.148, P=0.035）. ConclusionAs compared with the traditional surgery, the minimally invasive surgery has more advantages about the influence on the changes of pulmonary function and immune function, without obvious harmful effect on the stress response.