胸腔镜辅助超声刀切除术治疗食管癌效果及对患者创伤程度、凝血功能及肺功能的影响

Effect of thoracoscopy-assisted ultrasonic knife resection in the treatment of esophageal cancer and its influence on the degree of trauma,coagulation function and pulmonary function of patients

目的探讨胸腔镜辅助超声刀切除术治疗食管癌效果及对患者创伤程度、凝血功能及肺功能的影响。方法回顾性选取2017年4月至2020年4月滁州市中西医结合医院食管癌患者242例,依据治疗术式不同分为超声刀组(n=122)、电刀组(n=120)。电刀组采取胸腔镜辅助电刀切除术,超声刀组采取胸腔镜辅助超声刀切除术。统计2组患者手术情况、并发症发生情况,比较2组患者术前、术后1、3 d创伤程度指标[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、去甲肾上腺素(NE)、五羟色胺(5-HT)]、凝血功能[活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、纤维蛋白原(FIB)]水平及术前、术后1、2个月肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、第1秒用力呼气容积占用力肺活量比值(FEV1/FVC)]水平。结果超声刀组手术时间短于电刀组,淋巴结清扫数量高于电刀组,术后胸腔引流量、术中出血量均明显低于电刀组,差异均有统计学意义(P<0.05)。术后1、3 d时2组患者血清TNF-α、hs-CRP、NE、5-HT水平均高于术前,且超声刀组均明显低于电刀组,差异均有统计学意义(P<0.05)。2组患者术后1、3 d时APTT、D-D、FIB水平均明显高于术前,且超声刀组明显低于电刀组,差异均有统计学意义(P<0.05)。2组患者术后1、2个月时FEV1、FVC、FEV1/FVC水平均较术前明显降低,且超声刀组明显高于电刀组,差异均有统计学意义(P<0.05)。超声刀组并发症发生率(4.10%)明显低于电刀组(15.83%),差异有统计学意义(P<0.05)。结论胸腔镜辅助超声刀切除术应用于食管癌患者,有助于改善手术情况,减少并发症,且对创伤应激、凝血功能、肺功能的影响较小。

Objective To investigate the effect of thoracoscopic-assisted ultrasonic knife resection in the treatment of esophageal cancer and its influence on the degree of trauma,coagulation function and pulmonary function of patients. Methods From April 2017 to April 2020,242 patients with esophageal cancer in Chuzhou Hospital of Integrated Traditional Chinese and Western Medicine were retrospectively selected and divided into ultrasonic knife group(n = 122) and electrosurgical group(n = 120) according to different treatment procedures. Thoracoscopy-assisted electrosurgical resection was used in the electrosurgery group,and thoracoscopy-assisted ultrasonic resection in the ultrasonic knife group. The surgical status and complications of the two groups of patients were counted,and the trauma degree indexes [tumor necrosis factor-α(TNF-α),high sensitivity-C-reactive protein(hs-CRP),norepinephrine(NE),5-hydroxytryptamine(5-HT) ],coagulation function [activated partial thromboplastin time(APTT),D-dimer(D-D),fibrinogen(FIB) ] levels before surgery,1 day and 3 days after surgery,pulmonary function indicators [forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),and forced expiratory volume in the first second/force vital capacity(FEV1/FVC) ]levels before surgery,1 month and 2 months after surgery of the two groups were compared. Results The operation time of the ultrasonic knife group was shorter than that of the electrosurgical group,the number of lymph node dissection was higher than that of the electrosurgical group,the postoperative thoracic drainage and intraoperative blood loss were significantly lower than the electrosurgical group,the differences were statistically significant(P<0.05). The levels of serum TNF-α,hs-CRP,NE,and 5-HT in the 2 groups were higher than before surgery at 1 and 3 days after surgery,but the ultrasonic knife group were significantly lower than those in the electrosurgical group,the differences were statistically significant(P<0.05). The levels of APTT,D-D,and FIB on 1 day and 3 days after surgery in the 2 groups were significantly higher than those before the operation,but the ultrasonic knife group was significantly lower than the electrosurgical group,the differences were statistically significant(P<0.05). The levels of FEV1,FVC,FEV1/FVC at 1 month and 2 months after surgery in the 2 groups were significantly lower than before surgery,but the ultrasonic knife group was significantly higher than that in the electrosurgical group,the differences were statistically significant(P<0.05). The incidence of complications in the ultrasonic knife group(4. 10%) was significantly lower than that in the electrosurgical group(15. 83%),and the difference was significant(P<0.05). Conclusion The application of thoracoscopic assisted ultrasonic knife resection to patients with esophageal cancer is helpful to improve the operation situation,reduce complications,and has less impact on traumatic stress,coagulation function,and pulmonary function.