胸腹腔镜联合颈胸腹三切口食管癌根治颈部吻合术治疗食管癌患者的效果

Effect of Thoracic Laparoscopy Combined with Cervical Thoracic-Abdominal Three-Incisions Radical Resection of Esophageal Cancer and Neck Anastomosis in the Treatment of Patients with Esophageal Cancer

目的分析胸腹腔镜联合颈胸腹三切口食管癌根治颈部吻合术治疗食管癌患者的效果。方法选取南阳市第二人民医院2018年7月至2020年7月食管癌患者87例,根据手术方案分为观察组(n=44)和对照组(n=43),对照组接受常规开放式颈胸腹三切口食管癌根治术,观察组接受胸腹腔镜联合颈胸腹三切口食管癌根治颈部吻合术,比较两组淋巴结清扫数量、术中失血量、手术时间、住院时间、炎症因子[白介素-6(IL-6)、白介素-1β(IL-1β)、白介素-8(IL-8)]水平、免疫功能(淋巴细胞CD4^(+)、CD8^(+)水平)、术后并发症。结果观察组淋巴结清扫数量较对照组多,术中失血量较对照组小,手术时间、住院时间较对照组短(P<0.05);术后3 d两组血清IL-6、IL-1β、IL-8水平较术前高,但观察组较对照组低(P<0.05);术后3 d两组CD8^(+)、CD4^(+)水平较术前低,但观察组较对照组高(P<0.05);观察组术后肺炎、肺不张发生率较对照组低(P<0.05)。结论胸腹腔镜联合颈胸腹三切口食管癌根治颈部吻合术具有手术时间短、创伤低、术后恢复快优势,治疗食管癌患者可缩短康复进程,减轻应激反应,降低对免疫功能的影响,安全可靠。

Objective To analyze the effect of thoracic laparoscopy combined with cervical thoracic-abdominal three-incisions radical resection of esophageal cancer and neck anastomosis for esophageal cancer patients.Methods A total of 87 patients with esophageal cancer in Second People’s Hospital of Nanyang City from July 2018 to July 2020 were selected and divided into observation group(n=44) and control group(n=43) according to surgical plans.The control group received conventional open cervical thoracic abdomen three-incisions radical resection of esophageal cancer.The observation group received thoracic laparoscopy combined with cervical thoracic-abdominal three-incisions radical resection of esophageal cancer and neck anastomosis.The number of lymph node dissections,intraoperative blood loss,operation time,hospital stay,and inflammatory factors [interleukin-6(IL-6),interleukin-1β(IL-1β),interleukin-8(IL-8)] level,immune function(lymphocyte CD4^(+),CD8^(+) level),postoperative complications were compared between the two groups.Results The number of lymph node dissections in the observation group was more than that in the control group,the blood loss during the operation was less than that of the control group,and the operation time and hospital stay was shorter than those in the control group(P<0.05).The levels of IL-6,IL-1β,IL-8 were higher than that before operation,but the observation group was lower than that of the control group(P<0.05).The CD8^(+) and CD4^(+) levels of the two group were lower than that before operation 3 days after operation,but the observation group was higher than the control group(P<0.05).The incidence of postoperative pneumonia and atelectasis in the observation group was lower than that in the control group(P<0.05).Conclusion Thoracic laparoscopy combined with cervical thoracic-abdominal three-incisions radical resection of esophageal cancer and neck anastomosis has the advantages of short operation time,low trauma,and quick postoperative recovery.The treatment of patients with esophageal cancer can shorten the recovery process,reduce the stress response,reduce the immune function Impact,and be safe and reliable.