胸腹腔镜合食管癌切除术对食管癌患者肺功能、免疫功能的影响及颈部吻合口瘘的影响因素探讨

Effects of Thoracoscopic and Laparoscopic Esophagectomy on Pulmonary Function and Immune Function in Patients with Esophageal Cancer and the Influencing Factors of Cervical Anastomotic Fistula

目的:探讨胸腹腔镜下进行食管癌切除术对患者肺功能、免疫功能的影响,并分析颈部吻合口瘘的影响因素。方法:选择2016年8月至2021年8月期间我院收治的130例食管癌患者,均成功实施胸腹腔镜联合食管癌切除术,观察手术前后肺功能、免疫功能的变化情况。观察130例患者术后颈部吻合口瘘发生率,采用多因素Logistic回归分析颈部吻合口瘘的影响因素。结果:术后7d,患者的第1s用力呼气量(FEV1)、用力肺活量(FVC)、呼气流量峰值(PEF)较术前下降(P<0.05)。术后当天、术后7天,患者的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)较术前下降后升高,CD8^(+)较术前升高后下降(P<0.05)。130例患者术后有28例发生颈部吻合口瘘,发生率为21.54%。均为术后3~18 d内确诊为颈部吻合口瘘,按照是否发生颈部吻合口瘘将患者分为有吻合口瘘组(n=28)和无吻合口瘘组(n=102)。颈部吻合口瘘的发生与术前白蛋白、体质量指数(BMI)、糖尿病史、病变位置、吻合方式、手术时间、术中出血总量、重症呼吸室(ICU)时间、呼吸机使用时间、纤支镜吸痰次数、术后出现肺部感染、住院时间有关(P<0.05)。多因素Logisitic回归分析结果显示:术前白蛋白偏低、病变位置位于上段、术后出现肺部感染、糖尿病史、吻合方式为手工吻合、住院时间偏长是食管癌患者术后发生颈部吻合口瘘的危险因素(P<0.05)。结论:胸腹腔镜联合食管癌切除术治疗食管癌患者,可有效减轻免疫抑制,但不可避免的会影响机体的肺功能,且颈部吻合口瘘的发生受到术前白蛋白、病变位置、术后出现肺部感染等多方面的影响,应着重关注此类患者,以防吻合口瘘的发生。

Objective:To investigate the effect of thoracoscopic and laparoscopic esophagectomy on pulmonary function and immune function,and to analyze the influencing factors of cervical anastomotic leakage.Methods:130 patients with esophageal cancer who were treated in our hospital from August 2016 to August 2021 were selected,they were successfully treated with thoracoscopic and laparoscopic esophagectomy.The changes of pulmonary function and immune function before and after operation were observed.The incidence of cervical anastomotic leakage was observed in 130 patients.The influencing factors of cervical anastomotic leakage were analyzed by multivariate logistic regression.Results:On the 7th day after operation,the forced expiratory volume in the first second(FEV1),forced vital capacity(FVC)and peak expiratory flow(PEF)decreased compared with those before operation(P<0.05).On the day after operation and 7 days after operation,the CD3^(+),CD4^(+),CD4^(+)/CD8^(+)of the patients decreased and then increased,and the CD8^(+)increased and then decreased(P<0.05).Among 130 patients,28 cases developed cervical anastomotic leakage,with an incidence of21.54%.All patients were diagnosed as cervical anastomotic leakage within 3~18 d after operation.According to whether cervical anastomotic leakage occurred,the patients were divided into anastomotic leakage group(n=28)and non anastomotic leakage group(n=102).The incidence of cervical anastomotic leakage was related to preoperative albumin,body mass index(BMI),history of diabetes,location of lesion,anastomotic pattern,operative time,total bleeding during operation,ICU time,ventilator time,sputum frequency of sputum,postoperative pulmonary infection and length of stay(P<0.05).Multivariate Logisitic regression analysis showed that preoperative albumin was low,location of lesions located in the upper segment,postoperative lung infection,diabetes history,anastomosis method for manual anastomosis and longer hospital stay were risk factors for postoperative neck anastomotic leakage in patients with esophageal cancer(P<0.05).Conclusion:Thoracoscopy combined with laparoscopic esophagectomy in the treatment of patients with esophageal cancer can effectively reduce immunosuppression,but it will inevitably affect the body’s lung function.The occurrence of cervical anastomotic fistula is affected by preoperative albumin,lesion location,postoperative pulmonary infection and so on.We should pay special attention to such patients to prevent the occurrence of anastomotic fistula.