胸腹腔镜联合手术对食管癌患者炎症及创伤应激的影响

Effect of thoraco-laparoscopic surgery on inflammation and traumatic stress in patients with esophageal cancer

目的探究胸腹腔镜联合手术对食管癌患者炎症及创伤应激的影响。方法将60例食管癌患者按手术方式不同分为观察组及对照组,每组30例。对照组采用传统开胸手术治疗,观察组采用胸腹腔镜联合手术治疗,比较两组患者炎症指标、创伤应激指标、免疫功能指标、手术相关指标水平。结果术后,两组患者白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、皮质醇(Cor)、去甲肾上腺素(NE)水平均上升,且观察组患者IL-6、IL-8、TNF-α、CRP、Cor、NE水平均低于对照组,差异均有统计学意义(P﹤0.05)。术后,两组患者CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及自然杀伤(NK)细胞均下降,且观察组患者CD4^(+)、CD4^(+)/CD8^(+)及NK细胞均高于对照组,差异均有统计学意义(P﹤0.05)。观察组患者术中出血量少于对照组,手术时间、住院时间、肠道功能恢复时间均短于对照组,差异均有统计学意义(P﹤0.05)。结论食管癌患者采用胸腹腔镜联合手术治疗可降低机械性刺激引发的炎性反应及创伤应激反应,同时对机体免疫功能的影响较小,促进机体恢复,临床应用价值较高。

Objective To explore the effect of thoraco-laparoscopic surgery on inflammation and traumatic stress in patients with esophageal cancer.Method A total of 60 patients with esophageal cancer were divided into the observation group(n=30,treated with thoracic-laparoscopic surgery)and control group(n=30,treated with traditional open thoracic surgery);the inflammation,traumatic stress,immune function,and surgery-related indicators were compared.Result After surgery,the levels of interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),cortisol(Cor),and norepinephrine(NE)increased in both groups,with lower levels of IL-6,IL-8,TNF-α,CRP,Cor and NE in the observation group than those in the control group(P<0.05);after surgery,the CD4^(+),CD4^(+)/CD8^(+)and nature kill(NK)cell decreased in both groups,with higher levels in the observation group than those in the control group(P<0.05);intraoperative blood loss,operation time,hospital stay,and time to bowel function in the observation group were lower than those in the control group(P<0.05).Conclusion Thoracic-laparoscopic surgery for patients with esophageal cancer can reduce the inflammatory response and traumatic stress response caused by mechanical stimulation,meanwhile with small impact on the immune function,which can promote the recovery,and has higher clinical application value.