全腔镜Ivor-Lewis术治疗胸中下段食管癌的疗效及对免疫功能的影响

The clinical effect of total endoscopic Ivor-Lewis surgery in the treatment of middle and lower thoracic esophageal cancer and its influence on immunologic function

目的:对比全腔镜Ivor-Lewis术与McKeown手术治疗胸中下段食管癌的临床效果及对免疫功能的影响。方法:回顾性分析本院收治的132例胸中下段食管癌患者,行Ivor-Lewis术患者74例(Ivor-Lewis组),行McKeown手术者58例(McKeown组),比较两组患者围术期相关指标及并发症发生情况。采集术前、术后1 d、3 d、5 d静脉血,Elisa法检测免疫球蛋白IgA、IgM、IgG水平;流式细胞术检测血清中T淋巴细胞亚群比例变化情况。结果:与McKeown组相比,Ivor-Lewis组总手术时间降低,胸腔手术时间延长,腹腔手术时间缩短,胸管拔除时间、饮食恢复时间缩短,住院费用较高,Ivor-Lewis组吻合口瘘、喉返神经损伤发生率降低,差异均有显著性(P<0.05)。与术前相比,两组术后1 d、3 d、5 d IgA、IgG、IgM水平均降低,CD3+、CD4+、CD4+/CD8+水平均降低,Ivor-Lewis组术后1 d、3 d及McKeown组术后1 d、3 d、5 d CD8+水平均升高(P<0.05);Ivor-Lewis组IgA、IgG、IgM水平均高于McKeown组,CD3+、CD4+、CD4+/CD8+水平均高于McKeown组,CD8+水平低于McKeown组,差异有显著性(P<0.05)。Ivor-Lewis组肿瘤复发转移率低于McKeown组,生存率高于McKeown组,但差异无显著性(P>0.05)。结论:全腔镜Ivor-Lewis术治疗胸中下段食管癌患者手术操作时间短,安全性高,患者免疫功能恢复较快。

Objective:To compare the clinical effects of total endoscopic Ivor-Lewis surgery and McKeown surgery in the treatment of middle and lower thoracic esophageal cancer and their influences on immunologic function.Methods:A retrospective analysis of 132 patients with middle and lower thoracic esophageal cancer admitted in our hospital was carried out.74 patients underwent Ivor-Lewis surgery(Ivor-Lewis group),and 58 patients underwent McKeown surgery(McKeown group).Perioperative indicators and complications were compared between the two groups.Venous blood samples were collected before operation,and 1st,3rd,and 5th day after operation.The levels of immunoglobulin IgA,IgM and IgG were detected by Elisa,and the proportion of T lymphocyte subsets in serum was detected by flow cytometry.Results:Compared with McKeown group,Ivor-Lewis group had lower total operation time,longer thoracic operation time,shorter abdominal operation time,shorter thoracic tube extraction time,shorter diet recovery time,higher hospitalization costs,and lower incidence of anastomotic leakage and recurrent laryngeal nerve injury,and the differences were significant(P<0.05).Compared with pre-operation,the levels of IgA,IgG and IgM were decreased.The levels of CD3+,CD4+,CD4+/CD8+were decreased and the level of CD8+was increased on the post-operation 1st,3rd day in Ivor-Lewis group and post-operation 1st,3rd,5th day in McKeown group(P<0.05).The levels of IgA,IgG and IgM in Ivor-Lewis group were higher than those in McKeown group.The levels of CD3+,CD4+,CD4+/CD8+in Ivor-Lewis group were higher than those in McKeown group,and the level of CD8+in Ivor-Lewis group was lower than those in McKeown group.The differences were significant(P<0.05).The recurrence and metastasis rate of Ivor-Lewis group was lower than that of McKeown group,and the survival rate was higher than that of McKeown group,but there was no significant difference(P>0.05).Conclusion:Total endoscopic Ivor-Lewis surgery for middle and lower thoracic esophageal cancer has the advantages of short operation time,high safety,rapid recovery of immunologic function.