双镜联合微创手术对胸段食管癌患者肺功能及肿瘤微转移的影响

Effects of thoracoscopy combined with laparoscopy on lung function and tumor micrometastasis in patients with thoracic esophageal cancer

目的探究双镜联合微创手术对胸段食管癌患者肺功能及肿瘤微转移的影响。方法选取2017年7月至2019年7月于嘉兴市第二医院确诊为胸段食管癌并住院治疗的患者109例,根据治疗方式不同分为微创组(60例)和对照组(49例)。微创组在胸腔镜、腹腔镜辅助条件下进行手术,而对照组予以传统食管癌手术切除。比较两组患者的肺功能、红细胞免疫功能及病灶内侵袭基因表达量的差异。结果术后3 d,两组每分钟最大通气量(MVV)、1s用力呼气容积(FEV1)、肺活量(VC)较治疗前均下降(P<0.01),但微创组明显高于对照组[(69.90±7.07)vs(48.62±5.09),(75.12±7.93)vs(42.99±4.81),(74.57±7.30)vs(41.37±4.69)(P<0.01)];两组基质金属蛋白酶9(MMP9)、肿瘤坏死因子受体相关蛋白1(TRAP1)mRNA较治疗前均下降(P<0.01),而微创组明显高于对照组[(0.54±0.09)vs(0.42±0.06),(0.52±0.08)vs(0.41±0.06)(P<0.01)];两组Krüppel样因子4(KLF4)、钙粘附蛋白E(E-cad-herin)mRNA较治疗前均升高(P<0.01),而微创组明显低于对照组[(2.87±0.30)vs(3.17±0.36),(2.92±0.32)vs(3.19±0.38)(P<0.01)]。手术结束微创组红细胞免疫复合物花环率(RBC-ICR)较手术前1 d数值均有所升高(P<0.01),且术后1 d逐渐下降,术后3 d恢复至术前水平;手术结束微创组红细胞C3b受体花环率(RBC-C3bRR)、红细胞黏附肿瘤细胞花环率(TRR)较手术前1 d数值均下降(P<0.01),且术后1 d逐渐升高,术后3 d恢复至术前水平;除术前1 d外,微创组其余时间点的红细胞免疫功能各项指标与对照组比较差异有统计学意义[(手术结束时:(30.29±4.80)vs(34.68±5.47),(16.02±1.58)vs(12.03±1.17),(17.50±2.86)vs(12.59±2.26);术后1 d:(29.13±4.19)vs(35.01±5.29),(20.98±2.86)vs(16.23±2.40),(22.50±2.56)vs(17.39±2.34);术后3 d:(26.01±3.80)vs(31.50±5.01),(23.30±3.37)vs(18.02±2.79),(25.80±2.10)vs(21.19±2.60)(P<0.01)]。结论在行胸段食管癌根治术患者中,应用胸腔镜联合腹腔镜对其肺功能、红细胞免疫、肿瘤微转移的影响较小,值得推广。

Objective To investigate the effect of thoracoscopy combined with laparoscopy on lung function and tumor micrometastasis in patients with thoracic esophageal cancer.Methods 109 patients with thoracic esophageal cancer admitted from Mar.2018 to Jul.2019 in our hospital were divided into study group(60 cases)and the control group(49 cases).The study group underwent thoracoscopy and laparoscopy assisted surgery,while the control group underwent traditional surgical resection of esophageal cancer.The differences of lung function,RBC immune function and the expression of invasive gene in the lesions between the two groups were compared.Results Three days after the operation,maximum ventilation per minute(MVV),forced expiratory volume for 1 s(FEV1)and vital capacity(VC)of the two groups were all decreased(P<0.01),but they were significantly higher in the study group than in the control group[(69.90±7.07)vs(48.62±5.09),(75.12±7.93)vs(42.99±4.81),(74.57±7.30)vs(41.37±4.69)(P<0.01)].mRNA of matrix metalloproteinase 9(MMP9)and tumor necrosis factor receptor-related protein 1(TRAP1)in the two groups were all decreased(P<0.01),while they were significantly higher in the study group than in the control group[(0.54±0.09)vs(0.42±0.06),(0.52±0.08)vs(0.41±0.06)(P<0.01)].mRNA of Krüppel-like factor 4(KLF4)and E-cad-herin in the two groups were all increased(P<0.01),while it was significantly lower in the study group than in the control group[(2.87±0.30)vs(3.17±0.36),(2.92±0.32)vs(3.19±0.38)(P<0.01)].RBC immune complex rosette rate(RBC-ICR)in the study group was higher than that on the first day before operation(P<0.01),and gradually decreased from the first day after operation,and recovered to the preoperative level on the third day after operation.At the end of operation,red blood cell C3b receptor rosette rate(RBC-C3bRR)and red blood cell adhesion tumor cell rosette rate(TRR)in the study group were all decreased compared with those on the first day before operation(P<0.01),and gradually increased on the first day after operation in the study group,and recovered to the preoperative level on the third day after operation.Except for the first day before surgery,there were statistically significant differences in red blood cell immune function indexes at other time points between the study group and the control group[At the end of the operation:(30.29±4.80)vs(34.68±5.47),(16.02±1.58)vs(12.03±1.17),(17.50±2.86)vs(12.59±2.26);1 d after operation:(29.13±4.19)vs(35.01±5.29),(20.98±2.86)vs(16.23±2.40),(22.50±2.56)vs(17.39±2.34);3 d after operation:(26.01±3.80)vs(31.50±5.01),(23.30±3.37)vs(18.02±2.79),(25.80±2.10)vs(21.19±2.60)(P<0.01)].Conclusion In patients who need radical surgery for thoracic esophageal cancer,the application of thoracoscopy combined with laparoscopy has little effect on lung function,red blood cell immunity,and tumor micrometastasis,which is worth promoting.