胸腹腔镜联合食管癌根治术治疗对食管癌患者免疫功能、肺功能及预后生存的影响

Effect of Thoracic Laparoscopy Combined with Radical Esophageal Cancer Resection on Immune,Pulmonary Function and Prognosis of Patients with Esophageal Cancer

目的分析胸腹腔镜联合食管癌根治术对食管癌患者免疫功能、肺功能和预后生存的影响。方法回顾性分析2017年6月至2019年12月濮阳市清丰第一医院收治的80例食管癌患者的临床资料,根据手术方式的不同分为对照组和观察组各40例。收集所有研究对象临床资料,比较不同手术方式患者免疫功能、肺功能及术后并发症情况。对观察组患者随访资料进行记录,统计2 a内预后生存情况,分析影响预后的相关因素。结果(1)术后,两组CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、NK细胞水平较术前明显降低,且观察组明显高于对照组(P<0.05)。(2)术后5 d,观察组的FEV1、FVC较术前升高(P<0.05),而对照组未见明显差异(P>0.05);术后2个月,两组FEV1、FVC水平明显较术前及术后5 d升高,观察组较对照组升高尤甚(P<0.05);(3)观察组并发症发生率低于对照组(P<0.05)。(4)观察组生存率显著高于对照组(P<0.05)。(5)预后良好患者年龄≤60岁、无淋巴结转移、临床分期Ⅲ~Ⅳ期、术后有放化疗及胸腹腔镜联合根治治疗占比更高(P<0.05),进一步多因素分析结果显示,临床Ⅲ~Ⅳ期、有术后放化疗、有淋巴转移、传统根治术为影响胸腹腔镜联合食管癌根治术治疗食管癌患者预后生存的独立危险因素(P<0.05)。结论胸腹腔镜联合食管癌根治术可促进食管癌患者肺功能恢复,降低并发症的发生,对合并危险因素的高危患者进行合理的干预有利于提升术后生存率,改善预后。

Objective To analyze the effects of thoracic laparoscopy combined with radical esophageal cancer resection on immune,pulmonary function and prognosis of esophageal cancer patients.Methods Retrospective analysis was made on the clinical data of 80 patients with esophageal cancer admitted to our hospital from June 2017 to December 2019,and they were divided into the control group and the observation group with 40 patients each according to the different surgical methods.The clinical data of all subjects were collected to compare the immune function,pulmonary function and postoperative complications of 2 groups.The follow-up data of the patients in the observation group were recorded,the prognosis and survival within 2 years were counted,and the related factors affecting the prognosis were analyzed.Results(1)After operation,the levels of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)and NK cells in the two groups were significantly lower than those before operation,and those in the observation group were significantly higher than those in the control group(P<0.05).(2)FEV1 and FVC in the observation group increased 5 days after operation(P<0.05),but there was no significant difference in the control group(P>0.05);Two months after operation,FEV1 and FVC levels in the two groups were significantly higher than those before and 5 days after operation,especially in the observation group compared with the control group(P<0.05).(3)The incidence of complications in the observation group was lower than that in the control group(P<0.05).(4)The survival rate in the observation group was significantly higher than that in the control group(P<0.05).(5)The prognosis of patients with age≤60 years,no lymph node metastasis,clinical stageⅢ~Ⅳ,postoperative radiotherapy and chemotherapy,and combined thoraco laparoscopic radical surgery was good(P<0.05),Further multivariate analysis showed that clinical stageⅢ~Ⅳ,postoperative radiotherapy and chemotherapy,lymphatic metastasis,and traditional radical surgery were independent risk factors affecting the prognosis and survival of patients with esophageal cancer treated by thoracic laparoscopy combined with radical surgery(P<0.05).Conclusion Thoracic laparoscopy combined with radical esophageal cancer resection can promote the recovery of pulmonary function and reduce the incidence of complications in the patients,Reasonable intervention for high-risk patients is conducive to the postoperative survival rate and prognosis.