右胸入路食管癌根治术经食管胃胸腔与食管胃颈部吻合方式对中下段食管癌患者肺功能及PaO2、PaCO2的影响

Effect of Right Anesthesia Radical Surgery for Esophageal Carcinoma via Transesophageal Gastric Thoracic and Esophagogastric Neck on Pulmonary Function and PaO2,PaCO2 in Patients with Lower Middle Esophageal Cancer

目的分析右胸入路食管癌根治术食管胃胸腔和食管胃颈部吻合对中下段食管癌患者肺功能及动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)的影响。方法选取2017年10月至2019年10月无锡市第二人民医院收治的62例中下段食管癌患者,将其随机分为对照组31例,观察组31例,2组患者均给予经右胸入路食管癌根治术,对照组采用食管胃胸腔吻合方式,观察组采用食管胃颈部吻合方式。比较2组患者的手术时间、术中出血量、住院时间;比较2组术前、术后1周肺功能指标及PaO2、PaCO2水平;比较2组术后并发症、食管切端癌残留情况。结果2组患者手术时间、术中出血量无统计学意义(P>0.05),观察组患者住院天数明显短于对照组(P<0.05)。与术前比,术后1周2组肺活量(VC)、第1秒用力肺活量(FEV1)、用力肺活量(FVC)、最大通气量(MVV)、PaO2水平均明显下降,但观察组均高于对照组;2组患者术后1周PaCO2均较术前明显上升,但观察组低于对照组(P<0.05)。术后观察组并发症发生率与对照组比较差异无统计学意义(19.35%vs.16.13%,P>0.05);观察组食管切端癌残留率明显低于对照组(3.23%vs.12.91%,P<0.05)。结论经右胸入路食管癌根治术时采用食管胃颈部吻合相对于食管胃胸腔吻合方式,可缩短中下段食管癌患者住院时间,改善患者肺功能指标及血气分析指标。

Objective To analyze the effects of right anesthesia radical surgery for esophageal carcinoma via transesophageal gastric thoracic and esophagogastric neck on pulmonary function and PaO2,PaCO2 in patients with lower middle esophageal cancer.Results A total of 62 patients with middle and lower esophageal cancer admitted to Wuxi Second People's Hospital from October 2017 to October 2019 were randomly divided into control group of 31 cases and observation group of 31 cases.Patients in both groups were treated with radical thoracic approach for esophageal cancer,the control group used esophagogastric-thoracic anastomosis,and the observation group used esophagogastric-neck anastomosis.The operation time,intraoperative blood loss,and hospital stay were compared between the two groups.Pulmonary function indexes and PaO2 and PaCO2 levels were compared before operation and 1 week after operation.The incidence of postoperative complications and residual esophageal cancer were compared between the two groups.Results There was no significant difference in the operation time and intraoperative blood loss between the two groups of patients(P>0.05).The number of hospital stays in the observation group was significantly shorter than that in the control group(P<0.05).Compared with before operation,the levels of VC,FEV1,FVC,MVV,and PaO2 in the two groups decreased significantly after 1 week,but the observation group was higher than that in the control group;PaCO2 in the two groups increased significantly before operation,but the observation group was lower than the control group(P<0.05).There was no significant difference in the incidence of complications between the observation group and the control group after operation(19.35%vs.16.13%,P>0.05);the residual rate of esophageal end cancer in the observation group was significantly lower than that in the control group(3.23%vs.12.91%,P<0.05).Conclusion The use of esophagogastric neck anastomosis versus esophagogastric thoracic anastomosis during radical thoracic esophageal cancer surgery can shorten the length of hospital stay for patients with lower middle esophageal cancer,and improve pulmonary function and blood gas analysis.