胸腹腔镜手术对食管癌患者的近、远期疗效及血清因子动态变化和不良反应的影响

Clinical Study of the Effect of Laparoscopic Surgery on the Patients with Esophageal Cancer in the Near and Long Term,the Dynamic Changes of Serum Factors and Adverse Reactions

目的观察胸腹腔镜手术对食管癌患者的近、远期疗效,血清因子动态变化及不良反应的影响。方法选择186例食管癌患者,按病历编号随机分为观察组和对照组。观察组患者采用胸腹腔镜联合食管癌根治术(颈部吻合);对照组患者采用传统胸腹两切口食管癌根治术(食管胃胸内吻合)。统计患者手术中清扫淋巴结个数、血清因子含量及术中出血量、生活质量评分(QOL评分),并分析患者治疗的有效率及1年后治疗效果。结果观察组患者的QOL评分、术中出血量明显低于对照组(P<0.05)。观察组的临床治疗有效率[87.10%(81/93)]明显高于对照组的临床治疗有效率[70.97%(66/93)](P<0.05)。术后观察组患者血清中肿瘤标记物sMICA、YY1及Cyfra21-1明显低于对照组(P<0.05)。随访1年,观察组声音嘶哑发生率为[5.38%(5/93)]、复发或转移率为[6.45%(6/93)]、吻合口瘘发生率为[5.38%(5/93)]、肺部感染发生率为[2.15%(2/93)]及死亡率[3.23%(3/93)];对照组声音嘶哑发生率为10.75%(10/93)、复发或转移率为12.90%(12/93)、吻合口瘘发生率为8.60%(8/93)、肺部感染发生率为[3.23%(3/93)]及死亡率5.38%(5/93)。观察组不良反应总发生率[22.58%(21/93)]明显低于对照组[40.86%(38/93)],差异具有统计学意义(P<0.05)。结论采用胸腹腔镜联合食管癌根治术(颈部吻合)治疗食管癌患者术中出血量少、创伤小,术后并发症发生率低,安全性高,优化患者的远期疗效,值得临床借鉴。

Objective To observe the effects of thoracic and laparoscopic surgery on patients with esophageal cancer,and the changes of serum factors and adverse reactions.Methods 186 patients with esophageal cancer in the study were randomly selected and divided into the observation group and the control group according to the medical record number.The observation group was treated with thoracic laparoscopic combined with radical resection of esophageal cancer(cervical anastomosis).The control group was treated with radical resection of esophageal carcinoma with two incision(Intrathoracic anastomosis of esophagus and stomach).Patients in statistics of lymph node number,the amount of bleeding during operation and the content of serum factors,the quality of life score(QOL score)were recorded,and analyzed the efficiency and after 1-year curative effect in treatment of patients.Results The observation group of patients with blood loss,QOL score were significantly lower than the control group;clinical effective rate of the observation group[87.10%(81/93)]was significantly higher than the control group[70.97%(66/93)](P<0.05).After the operation,the observation group in serum tumor markers sMICA,YY1 and Cyfra21-1 were significantly lower than the control group(P<0.05).One year follow-up showed that hoarseness was[5.38%(5/93)],recurrence or metastasis rate was[6.45%(6/93)],anastomotic leakage was[5.38%(5/93)],pulmonary infection was[2.15%(2/93)]and mortality was[3.23%(3/93)]in the observation group;hoarseness,recurrence or metastasis rate,recurrence or metastasis rate,anastomotic leakage,anastomotic leakage,pulmonary infection,pulmonary infection and mortality were[10.75%(10/93)],[12.90%(12/93)],[8.60%(8/93)],[3.23%(3/93)]and[5.38%(5/93)],respectively.The total incidence of adverse reactions in the observation group was[22.58%(21/93)],which was significantly lower than[40.86%(38/93)]of the controlgroup(P<0.05).Conclusion The use of thoracic laparoscopic combined with radical resection of esophageal cancer(cervical anastomosis)in the treatment of esophageal cancer patients with less bleeding,less trauma,lower postoperative complication rate,high safety,optimize the long-term outcome of patients,is worthy of clinical reference.