胸腹腔镜McKeown根治术治疗对食管癌患者红细胞免疫、应激反应及肺功能的影响

Effects of laparoscopic McKeown radical thoracotomy on erythrocyte immunity, stress response and lung function in patients with esophageal cancer

目的探讨胸腹腔镜McKeown根治术治疗对食管癌患者红细胞免疫、应激反应及肺功能的影响。方法回顾性分析2016年10月至2021年11月昆山市第一人民医院收治的144例食管癌患者的临床资料。按不同手术方法分为对照组(n=71,腹腔镜联合上腹、左颈切口McKeown食管癌根治术)与研究组(n=73,胸腹腔镜McKeown根治术)。比较两组围手术期指标、红细胞免疫[红细胞C3b受体花环率(RBC-C3bRR)、红细胞免疫复合物花环率(RBC-ICR)、肿瘤红细胞花环率(TRR)]、应激反应[白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)]、1秒用力呼气量(FEV1)、用力肺活量(FVC)及并发症。结果两组手术时间、平均淋巴结清扫数目比较,差异无统计学意义(P>0.05);研究组术中出血量、腹腔引流时间及住院时间为(95.25±22.52)mL、(8.03±1.35)d、(10.15±2.69)d,均明显低于对照组[(123.36±19.87)mL、(11.29±2.63)d、(12.71±3.05)d],差异均有统计学意义(P<0.05)。两组手术后RBC-C3bRR、TRR均较手术前降低,RBC-ICR水平较手术前增高,研究组RBC-C3bRR、TRR为(16.28±1.02)%、(20.27±2.65)%,均明显高于对照组[(12.41±1.22)%、(15.53±1.58)%],RBC-ICR为(28.26±3.64)%,低于对照组[(33.24±4.01)%],差异均有统计学意义(P<0.05)。手术后两组IL-6、TNF-α及CRP水平均较手术前增高,研究组IL-6、TNF-α及CRP水平为(3.25±0.28)ng/mL、(3.52±0.18)ng/mL、(5.54±1.25)mg/L,均低于对照组[(6.13±0.36)ng/mL、(5.63±0.32)ng/mL、(10.34±2.25)mg/L],差异均有统计学意义(P<0.05)。两组手术后FEV1、FVC均较手术前降低,研究组FEV1、FVC及FEV1/FVC为(1.89±0.47)L、(2.53±0.27)L、(0.64±0.06),均明显高于对照组[(1.06±0.44)L、(1.89±0.23)L、(0.51±0.03)],差异均有统计学意义(P<0.05)。研究组并发症总发生率为13.70%,明显低于对照组(29.58%),差异有统计学意义(P<0.05)。结论胸腹腔镜McKeown根治术治疗食管癌患者效果显著,可减轻患者红细胞免疫及应激反应,改善肺功能,且具有一定安全性。

Objective To investigate the effects of laparoscopic McKeown radical surgery on erythrocyte immunity,stress response and lung function in patients with esophageal cancer.Methods The clinical data of 144 patients with esophageal cancer admitted to Kunshan first people's Hospital from October 2016 to November 2021 were retrospectively analyzed.According to different surgical methods,the patients were divided into control group(n=71,laparoscopic combined with upper abdomen and left neck incision McKeown resection)and study group(n=73,thoracic laparoscopic McKeown resection).The perioperative indexes,[red blood cell C3b receptor rosette rate(RBC-C3bRR),red blood cell immune complex rosette rate(RBC-ICR),stress response[tumor RBC rosette(TRR)],interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),C-reactive protein(CRP)],forced expiratory volume in 1 second(FEV1),forced vital capacity(FVC)and complications were compared between the two groups.Results There was no difference in operation time and average number of dissected lymph nodes between the two groups(P>0.05);the amount of intraoperative blood loss,abdominal drainage time and hospitalization time in the study group were(95.25±22.52)mL,(8.03±1.35)d,(10.15±2.69)d,which were significantly lower than those in the control group[(123.36±19.87)mL,(11.29±2.63)d,(12.71±3.05)d],which were significantly lower than those in the control group,the differences were statistically significant(P<0.05).The levels of RBC-C3BRR,TRR in the two groups were lower than those before operation,and the levels of RBC-ICR were higher than those before operation,while the levels of RBC-C3BRR,TRR were(16.28±1.02)%and(20.27±2.65)%in the study group,which were significantly higher than those in the control group[(12.41±1.22)%and(15.53±1.58)%],the level of RBC-ICR was(28.26±3.64)%,which was lower than that of control group[(33.24±4.01)%],the differences were statistically significant(P<0.05).The levels of IL-6,TNF-αand CRP in two groups after operation were higher than those before operation,the levels of IL-6 and TNF-αand CRP in the study group levels were(3.25±0.28)ng/mL,(3.52±0.18)ng/mL,(5.54±1.25)mg/L,which were lower than those in the control group[(6.13±0.36)ng/mL,(5.63±0.32)ng/mL,(10.34±2.25)mg/L],the differences were statistically significant(P<0.05).The levels of FEV1,FVC and FEV1/FVC in the two groups after operation were lower than before operation,while the levels of FEV1,FVC and FEV1/FVC in the study group were(1.89±0.47)L,(2.53±0.27)L,(0.64±0.06),which were significantly higher than those in the control group[(1.06±0.44)L,(1.89±0.23)L,(0.51±0.03)],the differences were statistically significant(P<0.05).The total incidence of complications in the study group was 13.70%,which was significantly lower than that in the control group(29.58%),the difference was statistically significant(P<0.05).Conclusion Laparoscopic McKeown has a significant effect on the treatment of esophageal cancer,which can reduce erythrocyte immunity and stress response,improve lung function,and has a certain safety.