胸腔镜下经左胸全机械侧侧吻合在下段食管癌切除中的效果及其对呼吸功能的影响

Effects of Thoracoscopic Left Lateral Mechanical Lateral Anastomosis on Resection of Lower Esophageal Carcinoma and Its Effect on Respiratory Function

目的探讨胸腔镜下经左胸全机械侧侧吻合在下段食管癌切除中的效果及其对呼吸功能的影响。方法2014年4月到2017年2月选择90例下段食管癌患者作为研究对象,根据随机信封抽签原则分为观察组与对照组,各45例。观察组采用胸腔镜下经左胸全机械侧侧吻合术,对照组采用吻合器进行颈部食管胃端侧吻合术。记录手术效果与呼吸功能的变化。结果观察组与对照组术后14 d的FEV1/FVC值分别为(53.31±15.23)%和(46.04±10.93)%,都明显高于术前1 d的(33.63±12.51)%和(33.94±12.39)%(P<0.05);治疗后观察组的FEV1/FVC值也高于对照组(P<0.05)。观察组的术中出血量、吻合时间、术后住院时间都明显少于对照组(P<0.05),但2组手术时间差异无统计学意义(P>0.05)。观察组与对照组术后14 d的血清IL-6与TNF-α都明显高于术前1 d(P<0.05),但观察组术后14 d的血清IL-6与TNF-α明显低于对照组(P<0.05)。观察组术后1个月的肺部感染、胸胃综合征、吻合口狭窄、吻合口瘘等并发症总发生率为8.9%,显著低于对照组的31.1%(P<0.05)。结论胸腔镜下经左胸全机械侧侧吻合在下段食管癌切除中的应用具有更好的微创性,能减少术后并发症的发生,促进患者呼吸功能的恢复,减轻组织炎症反应,有很好的应用价值。

Objective To investigate the effects of thoracoscopic left lateral mechanical lateral anastomosis on resection of lower esophageal carcinoma and its effect on respiratory function. Methods 90 cases of lower esophageal cancer patients were selected and divided into the observation group and the control group,with 45 cases in each group,according to the random draw envelope principle. The observation group was given thoracoscopic left lateral mechanical lateral anastomosis,the control group used the anastomosis for esophagogastrostomy with end to side anastomosis,the operation effect and respiratory function changes were recorded. Results The postoperative 14 d FEV1/FVC values in the observation group and control group were 53. 31 ±15. 23% and 46. 04 ± 10. 93% which were significantly higher than the preoperative 1 d of 33. 63 ± 12. 51% and 33. 94 ±12. 39%（ P〈0. 05）,the observation group was higher than that of the control group（ P〈0. 05）. The intraoperative blood loss,the time of anastomosis and the length of hospital stay in the observation group were significantly less than those of the control group（ P〈0. 05）,and there was no significant difference in the operation time between the 2 groups（ P〉0. 05）. The postoperative 14 d serum levels of IL-6 and TNF-α in the observation group and the control group were significantly higher than those of preoperative 1 d（ P〈0. 05）,and the observation group were significantly lower than those of the control group（ P〈0. 05）（ 14 d）. The postoperative 1 month of pulmonary infection,thoracic stomach syndrome,anastomotic stenosis,anastomotic fistula and complication rate in the observation group was 8. 9%,and 31. 1% in the control group,the observation group was significantly less than the control group（ P〈0. 05）. Conclusion Thoracoscopic left lateral mechanical lateral anastomosis on resection of lower esophageal carcinoma and its effect on respiratory function has better minimally invasive,it can reduce postoperative complications and promote the recovery of the patient＇s respiratory function,reduce inflammation,and it has very good application values.