腹腔镜辅助Ivor-Lewis与McKeown术治疗老年食管癌的效果比较

Comparison on effects of laparoscopic Ivor Lewis versus McKeown procedures on elderly patients with esophageal cancer

目的比较腹腔镜辅助经腹胸二切口食管癌根治胸内吻合术(Ivor-Lewis术)与经颈胸腹三切口食管癌根治颈部吻合术(McKeown)治疗老年食管癌的临床效果。方法抽取2018年1月至2020年1月于郑州大学附属洛阳中心医院接受腹腔镜辅助治疗的老年食管癌患者85例,对其临床资料进行回顾性分析。行Ivor-Lewis术进行治疗的39例患者作为Ivor-Lewis组,行McKeown术进行治疗的46例患者作为McKeown组。比较两组患者的手术情况、围术期免疫功能、应激反应及肠道屏障功能。结果Ivor-Lewis组手术时间为(150.81±25.73)min,住院时间为(12.67±2.08)d,均短于McKeown组的(165.62±30.48)min、(15.39±2.47)d(P均<0.05)。术后1 h、1 d、3 d,Ivor-Lewis组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于McKeown组(P<0.05);Ivor-Lewis组皮质醇、C反应蛋白、白细胞介素-6水平均低于McKeown组(P均<0.05);Ivor-Lewis组二胺氧化酶、D-乳酸水平均低于McKeown组(P均<0.05)。结论腹腔镜辅助Ivor-Lewis与McKeown术式对老年食管癌患者的疗效相近,但Ivor-Lewis术能缩短患者的手术时间和住院时间,改善患者的免疫功能,对机体应激反应、肠道屏障功能的影响较小。

Objective To compare the clinical effects of laparoscopic transabdominal and transthoracic Ivor-Lewis esophagectomy(Ivor-Lewis)versus transcervical,transchest and transabdominal McKeown esophagectomy(McKeown)on elderly patients with esophageal cancer.Methods A total of 85 elderly patients with esophageal cancer who underwent laparoscopic assisted treatment in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2018 to January 2020 were selected.And the clinical data of the 85 elderly patients were retrospectively analyzed.The Ivor-Lewis group included 39 patients who underwent Ivor-Lewis operation,and the McKeown group included 46 patients who underwent McKeown operation.The operation status,perioperative immune function,stress response,and intestinal barrier function were compared between the two groups.Results The operation time and hospitalization time in Ivor-Lewis group were(150.81±25.73)min and(12.67±2.08)d,respectively,shorter than the(165.62±30.48)min and(15.39±2.47)d in McKeown group(allP<0.05).Cluster of differentiation(CD)3^(+),CD4^(+)and CD4^(+)/CD8^(+)in Ivor-Lewis group were higher than those in McKeown group 1 h,1 d and 3 d after surgery(P<0.05).The levels of cortisol,C-reactive protein,and interleukin-6 in Ivor-Lewis group were lower than those in McKeown group(all P<0.05).The diamine oxidase and D-lactic acid in Ivor-Lewis group were lower than those in McKeown group(all P<0.05).Conclusions The curative effect of laparoscopic assisted Ivor-Lewis is comparable to that of McKeown surgery on elderly patients with esophageal cancer.However,Ivor-Lewis can shorten operation time and hospitalization time,and improve immune function,with fewer influence on stress response and intestinal barrier function.