食管胃颈部吻合与食管胃胸腔吻合在中下段食管癌经右胸入路根治术中的应用效果比较

Comparison of efficacy of esophagogastric neck anastomosis versus esophagogastric thoracic anastomosis in radical resection of middle and lower esophageal cancer via right thoracic approach

目的比较食管胃颈部吻合与食管胃胸腔吻合在中下段食管癌经右胸入路根治术中的应用效果。方法抽取2020年3月至2022年4月南阳市第一人民医院收治的中下段食管癌患者91例,根据患者入院单单双号分为对照组(46例)与研究组(45例);全部患者均接受右胸入路根治术治疗,对照组术中采用食管胃胸腔吻合,研究组术中采用食管胃颈部吻合;记录并比较两组手术相关指标;术前、术后1周,检测两组肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大通气量(MVV)]、免疫功能[自然杀伤细胞(NK)、CD4^(+)、CD8^(+)];记录并比较两组并发症发生情况。结果两组手术耗时及术中出血量比较差异未见统计学意义(P>0.05);研究组术中淋巴结清扫数目高于对照组,总住院时间短于对照组(P<0.05);术前两组肺功能指标、免疫功能指标比较差异未见统计学意义(P>0.05);术后1周,研究组FVC、MVV、FEV1、CD4^(+)高于对照组,CD8^(+)低于对照组,差异有统计学意义(P<0.05);两组并发症发生率比较差异未见统计学意义(P>0.05)。结论中下段食管癌经右胸入路根治术采用食管胃颈部吻合可增加淋巴结清扫数目,减轻对肺功能的影响,利于免疫功能的恢复,且并发症少。

ObjectiveTo compare the clinical efficacy of esophagogastric neck anastomosis and esophagogastric thoracic anastomosis in radical resection of middle and lower esophageal cancer via right thoracic approach.MethodsA total of 91 patients with middle and lower esophageal cancer treated in Nanyang First People’s Hospital from March 2020 to April 2022 were selected,and they were divided into control group(46 cases)and study group(45 cases)according to the odd or even number of their admission numbers.All patients were treated by radical resection via right thoracic approach;the control group was treated by esophagogastric thoracic anastomosis,and the study group was treated by esophagogastric neck anastomosis.The operation related indexes of the two groups were recorded and compared;pulmonary function indexes,including forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1)and maximal voluntary ventilation(MVV),immune function indexes,including natural killer cells(NK),cluster of differentiation 4^(+)(CD4^(+))and cluster of differentiation 8^(+)(CD8^(+)),of the two groups were measured and compared before and 1 week after operation.The complications of the two groups were recorded and compared.ResultsThere was no significant difference in operation time and intraoperative bleeding between the two groups(P>0.05);the number of lymph node dissected in the study group was more than that in the control group,and the total hospital stay of the study group was shorter than that of the control group(P<0.05).There was no significant difference in pulmonary function indexes and immune function indexes between the two groups before operation(P>0.05).The FVC,MVV,FEV1,NK and CD4^(+)in the study group were higher than those in the control group,while CD8^(+)was lower than that in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).ConclusionsEsophagogastric neck anastomosis,in radical resection via right thoracic approach,can increase the number of lymph nodes dissected,reduce the impact on pulmonary function and conducive to the recovery of immune function in patients with middle and lower esophageal cancer,with fewer complications.