不同路径下腔镜微创贲门癌根治术的疗效及对术后残余胃肠功能营养状况的影响

Efficacy of Laparoscopic Minimally Invasive Radical Surgery for Esophageal Cancer via Different Approaches and Its Impact on Postoperative Residual Gastrointestinal Function and Nutritional Status

目的:探讨不同路径下腔镜微创贲门癌根治术的疗效及对术后残余胃肠功能、营养状况的影响。方法:选取2020年5月至2023年5月我院贲门癌患者126例,随机数字表法分为经腹组与经胸腹组,各63例。经腹组给予腹腔镜微创根治术,经胸腹组给予胸腹联合腔镜微创根治术。对比两组疗效、围术期情况、创伤指标[手术前后C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平]、胃肠功能指标[术后拔胃管时间、肛门排气时间、进食时间、手术前后血管活性肠肽(VIP)、生长抑素(SS)、胃动素(MTL)水平]、营养状况[手术前后血清白蛋白(ALB)、预后营养指数(PNI)、主观综合营养评估法(SGA)评分]及术后并发症。结果:两组切缘阳性率、手术根治率对比,差异无统计学意义(P>0.05);经胸腹组手术时间为(131.52±18.77)min,术后肛门排气时间(2.52±0.60)d、术后拔胃管时间(2.88±0.47)d、术后进食时间(4.38±0.85)d、术后下床时间(5.82±1.16)、住院时间(10.72±2.01)d,均短于经腹组的(155.94±21.67)min、(3.40±0.66)d、(3.34±0.53)d、(5.62±0.92)d、(7.10±1.24)d、(12.39±2.33)d,术中出血量、术后引流量分别为(112.46±14.21)mL、(160.89±22.37)mL,均低于经腹组的(124.31±16.08)mL、(186.27±20.15)mL,淋巴结清扫数目为(15.27±1.76)个,高于经腹组的(13.15±1.63)个(t=6.761、7.831、5.154、7.858、5.983、4.308、4.383、6.691、7.015,P均<0.001);术后1d、3d,经胸腹组血清CRP分别为(72.36±16.20)mg/L、(35.28±10.08)mg/L,低于经腹组的(96.58±14.77)mg/L、(51.17±11.62)mg/L,IL-6分别为(212.34±33.16)ng/L、(142.32±23.57)ng/L,低于经腹组的(254.39±37.49)ng/L、(180.67±27.13)ng/L,IL-8分别为(0.28±0.09)μg/L、(0.14±0.04)μg/L,低于经腹组的(0.42±0.11)μg/L、(0.25±0.07)μg/L,VIP分别为(28.76±4.05)pg/mL、(34.69±4.28)pg/mL,高于经腹组的(25.14±3.63)pg/mL、(30.52±3.91)pg/mL,SS分别为(18.23±3.10)pg/mL、(20.21±2.36)pg/mL,高于经腹组的(16.17±2.86)pg/mL、(18.08±2.44)pg/mL,MTL分别为(242.16±21.18)pg/mL、(257.90±23.25)pg/mL,高于经腹组的(227.43±20.64)pg/mL、(238.41±21.76)pg/mL,(t=8.769、8.199、6.668、8.470、7.818、10.829、5.283、5.709、3.877、4.980、3.953、4.858,P均<0.001);术后1个月,经胸腹组血清ALB、差值分别为(75.61±8.03)g/L、(11.95±6.51)g/L,高于经腹组的(70.58±5.95)g/L、(70.58±5.95)g/L,PNI、差值分别为(62.48±6.17)、(14.22±5.13)g,高于经腹组的(57.13±5.82)、(8.60±5.22),SGA评分与差值分别为(9.08±1.42)分、(5.49±1.58)分,高于经腹组的(11.15±1.76)分、(3.06±1.49)分(t=3.944、4.8470、5.007、6.095、7.265、8.881,P均<0.001);经胸腹组并发症发生率为6.35%,低于经腹组的19.05(χ^(2)=4.582,P=0.032)。结论:胸腹联合腔镜微创根治术治疗贲门癌效果确切,能优化手术路径,减轻组织创伤,有助于恢复胃肠功能,改善患者营养状态,减轻并发症发生,加快术后恢复进程。

Objective:To investigate the efficacy of laparoscopic minimally invasive radical surgery for esophageal cancer via different approaches and its influence on postoperative residual gastrointestinal function and nutritional status.Methods:A total of 126 patients with esophageal cancer admitted to our hospital from May 2020 to May 2023 were selected and randomly divided into two groups:the transabdominal group and the thoracoabdominal group,with 63 cases in each group.The transabdominal group underwent laparoscopic minimally invasive radical surgery,while the thoracoabdominal group underwent thoracoabdominal combined laparoscopic minimally invasive radical surgery.The efficacy,perioperative conditions,trauma indicators[pre-and postoperative levels of C-reactive protein(CRP),interleukin-6(IL-6),interleukin-8(IL-8)],gastrointestinal function indicators[postoperative gastric tube removal time,anal exhaust time,eating time,pre-and postoperative levels of vasoactive intestinal peptide(VIP),somatostatin(SS),motilin(MTL)],nutritional status[pre-and postoperative serum albumin(ALB),prognostic nutritional index(PNI),subjective global assessment(SGA)score],and postoperative complications were compared between the two groups.Results:The comparison of positive margin rate,surgical cure rate between the two groups showed no statistical significance(P>0.05);the thoracoabdominal group had shorter operative time(131.52±18.77)min,postoperative anal exhaust time(2.52±0.60)d,postoperative nasogastric tube removal time(2.88±0.47)d,postoperative oral intake time(4.38±0.85)d,postoperative ambulation time(5.82±1.16)d,and hospital stay(10.72±2.01)d,all shorter than those of the abdominal group[(155.94±21.67)min,(3.40±0.66)d,(3.34±0.53)d,(5.62±0.92)d,(7.10±1.24)d,(12.39±2.33)d,respectively],intraoperative blood loss,and postoperative drainage volume were(112.46±14.21)mL and(160.89±22.37)mL,respectively,both lower than those of the abdominal group[(124.31±16.08)mL,(186.27±20.15)mL,respectively],the number of lymph nodes dissected was(15.27±1.76),higher than that of the abdominal group(13.15±1.63)(t=6.761,7.831,5.154,7.858,5.983,4.308,4.383,6.691,7.015,all P<0.001);on postoperative days 1 and 3,serum CRP levels of the thoracoabdominal group were(72.36±16.20)mg/L and(35.28±10.08)mg/L,respectively,lower than those of the abdominal group[(96.58±14.77)mg/L and(51.17±11.62)mg/L,respectively],IL-6 levels were(212.34±33.16)ng/L and(142.32±23.57)ng/L,respectively,lower than those of the abdominal group[(254.39±37.49)ng/L and(180.67±27.13)ng/L,respectively],IL-8 levels were(0.28±0.09)μg/L and(0.14±0.04)μg/L,respectively,lower than those of the abdominal group[(0.42±0.11)μg/L and(0.25±0.07)μg/L,respectively],VIP levels were(28.76±4.05)pg/mL and(34.69±4.28)pg/mL,respectively,higher than those of the abdominal group[(25.14±3.63)pg/mL and(30.52±3.91)pg/mL,respectively],SS levels were(18.23±3.10)pg/mL and(20.21±2.36)pg/mL,respectively,higher than those of the abdominal group[(16.17±2.86)pg/mL and(18.08±2.44)pg/mL,respectively],MTL levels were(242.16±21.18)pg/mL and(257.90±23.25)pg/mL,respectively,higher than those of the abdominal group[(227.43±20.64)pg/mL and(238.41±21.76)pg/mL,respectively](t=8.769,8.199,6.668,8.470,7.818,10.829,5.283,5.709,3.877,4.980,3.953,4.858,all P<0.001);1 month postoperatively,serum ALB and the difference values of the thoracoabdominal group were(75.61±8.03)g/L and(11.95±6.51)g/L,respectively,higher than those of the abdominal group[(70.58±5.95)g/L and(70.58±5.95)g/L,respectively],PNI and the difference values were(62.48±6.17)and(14.22±5.13)g,respectively,higher than those of the abdominal group[(57.13±5.82)and(8.60±5.22),respectively],SGA scores and the difference values were(9.08±1.42)points and(5.49±1.58)points,respectively,higher than those of the abdominal group[(11.15±1.76)points and(3.06±1.49)points,respectively](t=3.944,4.8470,5.007,6.095,7.265,8.881,all P<0.001);the incidence of complications in the thoracoabdominal group was 6.35%,lower than that in the abdominal group of 19.05%(χ^(2)=4.582,P=0.032).Conclusion:Thoracoabdominal combined laparoscopic minimally invasive radical surgery for esophageal cancer is effective,can optimize the surgical pathway,reduce tissue trauma,help restore gastrointestinal function,improve patient nutritional status,reduce the incidence of complications,and accelerate postoperative recovery.