全胸腔镜食管癌根治术的治疗效果及对血清CRP、TNF-α水平和肺功能的影响

The curative effects of total thoracoscopic radical surgery on esophageal cancer and its influence on the serum levels of CRP,TNF-α and pulmonary function of patients

目的探讨全胸腔镜食管癌根治术治疗食管癌患者的效果和对患者肺功能、血清C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)的影响。方法手术治疗的93例食管癌患者进行回顾性分析,根据手术方法分为胸腔镜组45例、传统开胸手术(传统组)48例,比较2组患者术后肺功能[第1秒用力呼气容积(FEV1)、用力肿活量(FVC)、每分钟最大通气量(MVV)]、血气CRP、TNF-α水平及围手术期相关指标。结果腹腔镜组的手术时间、术中出血量、手术后第1天引流量、总引流量均低于传统组,差异有统计学意义(P<0.05);2组淋巴结清扫数目差异无统计学意义(P>0.05);术后2周,腹腔镜组的FEV1、FVC、MVV检测值均高于传统组,差异有统计学意义(P<0.05);术后2周,腹腔镜组的血清CRP、TNF-α检测值均低于传统组,差异有统计学意义(P<0.05);腹腔镜组的手术并发症率低于传统组,差异有统计学意义(P<0.05)。结论全胸腔镜食管癌根治术治疗食管癌患者较开胸手术具有手术创伤小、术后炎症反应低、对患者肺功能影响更小的优势。

Objective To investigate the therapeutic effects of total thoracic esophageal cancer radical resection surgery and its influence on lung function,the erum levels of C reactive protein(CRP)and tumor necrosis factor alpha(TNF-α)of patients with esophageal cancer.Methods The clinical dat about 93 patients of esophageal cancer who received surgical treatment in our hospital from January 2015 to May 2016 were retrospectively analyzed.According to the operation method,the patients were divided into VATS group(n=45)and conventional thoracotomy group(traditional surgery group,n=48).The pulmonary function indexes including force expiratory volume in the first second(FEV1),forced vital capacity(FVC),maximum voluntary ventilation(MVV),the serum levels of serum CRP and TNF-α,and the related perioperative indexes were observed and compared between the two groups.Results The operation time,intraoperative bleeding volume,drainage volume at 1 day after operation and the total volume of drainage in VATS group were significantly lower than those in traditional surgery group(P<0.05).However there was no significant difference in the number of lymph node dissection between two groups(P<0.05).The levels of FEV1,FVC,MVV in VATS group were significantly higher than those in traditional surgery group at 2 weeks after surgery(P<0.05).At 2 weeks after operation,the serum levels of CRP,TNF-αof patients in VATS group were significantly lower than those in traditional surgery group(P<0.05).The incidence rate of complications in VATS group was 8.89%,which was significantly lower than that(27.08%)in traditional surgery group(P<0.05).Conclusion The total thoracoscopic radical surgery in treatment of esophageal cancer has advantages of less surgical trauma,lower degree of postoperative inflammation,less impact on the lung function of patients,as compard with those by thoracotomy.