胸腹腔镜联合Ivor Lewis食管癌根治术对食管癌患者肺功能、红细胞免疫及应激反应的影响

The Effect of Thoracoscope Combined with Ivor Lewis Esophagectomy on Pulmonary Function, RBC Immunity and Stress Response in Patients with Esophageal Cancer

目的:探讨胸腹腔镜联合Ivor Lewis食管癌根治术对食管癌患者红细胞免疫、肺功能及应激反应的影响。方法:选取2016年5月~2018年6月期间我院收治的食管癌患者150例。根据随机数字表法将患者分为A组(n=75)和B组(n=75),A组予以开胸Ivor Lewis食管癌根治术,B组予以胸腹腔镜联合Ivor Lewis食管癌根治术,比较两组围术期指标、肺功能、红细胞免疫、应激反应及并发症。结果:B组手术时间、住院时间短于A组,术中出血量少于A组(P<0.05);两组清扫淋巴结数目比较无差异(P>0.05)。两组术后1个月第1秒末用力呼气容积(FEV1)、用力呼吸肺活量(FVC)、FEV1/FVC均降低,但B组高于A组(P<0.05)。两组术后3d白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)均升高,但B组低于A组(P<0.05)。两组术后3d红细胞免疫复合物花环率(RBC-ICR)升高,但B组低于A组(P<0.05);红细胞C3b受体花环率(RBC-C3bRR)、肿瘤红细胞花环率(TRR)降低,但B组高于A组(P<0.05)。两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论:胸腹腔镜联合Ivor Lewis食管癌根治术治疗食管癌患者,可有效改善围术期各项指标,减轻对机体肺功能、红细胞免疫及应激反应的影响,且不增加并发症发生率。

Objective: To investigate the effect of thoracoscopic combined with Ivor Lewis esophagectomy on red cell immunity,lung function and stress response in patients with esophageal cancer. Methods: 150 patients with esophageal cancer were selected from May 2016 to June 2018. The patients were divided into group A(n=75) and group B(n=75) according to the method of random number table. Group A was treated with radical resection of Ivor Lewis esophageal cancer and group B with laparoscopic resection of Ivor Lewis esophageal cancer. The perioperative indexes, lung function, red cell immunity, stress response and complications were compared between the two groups. Results: The operation time and hospitalization time of group B were shorter than that of group A, and the amount of bleeding during operation was less than that of group A(P<0.05). There was no difference in the number of lymph nodes cleaned between the two groups(P>0.05). The forced expiratory volume(FEV1), forced respiratory vital capacity(FVC) and FEV1/FVC decreased at 1 month after operation, but group B was higher than group A(P<0.05). The levels of interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), C-reactive protein(CRP) were all increased in the two groups at 3 d after operation, but the group B was lower than that in group A(P<0.05). The rosette rate of RBC immune complex(RBC-ICR)in group B was lower than that in group A at 3 d after operation(P<0.05), while the erythrocyte C3 b receptor rosette rate(RBC-C3 bRR), tumor rosette rate(TRR) decreased, and the group B were lower than those in group A(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion: Thoracoscopy combined with Ivor Lewis esophagectomy for esophageal cancer can effectively improve the perioperative indicators, reduce the impact on lung function, red cell immunity and stress response, and do not increase the incidence of complications.