胸腹腔镜联合Ivor Lewis食管癌根治术对食管癌患者肺功能、血清炎症因子及免疫功能的影响

Effects of thoracic laparoscopy combined with Ivor Lewis radical resection for esophageal cancer on lung function,serum inflammatory factor and immune function in patients with esophageal cancer

目的 探讨胸腹腔镜联合Ivor Lewis食管癌根治术对食管癌患者肺功能、血清炎症因子及免疫功能的影响。方法 将90例食管癌患者按手术方式的不同分为常规组(46例)和微创组(44例),常规组患者采取开胸Ivor Lewis食管癌根治术,微创组患者采取胸腹腔镜联合Ivor Lewis食管癌根治术。比较两组患者围手术期相关指标、肺功能指标[最大自主通气量(MVV)、肺活量(VC)、第1秒用力呼气容积(FEV_(1))]、血清炎症因子[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)]及免疫功能指标[免疫球蛋白G(IgG)、免疫球蛋白A(IgA)]。结果 微创组患者手术时间、住院时间均明显短于常规组,淋巴结清扫数明显多于常规组,术中出血量明显少于常规组,差异均有统计学意义(P﹤0.01)。术后1个月,两组患者VC、MVV、FEV_(1)均低于本组术前,微创组患者VC、MVV、FEV_(1)均高于常规组,差异均有统计学意义(P﹤0.05)。术后3天,两组患者IL-6、CRP、PCT、IgA、IgG水平均高于本组术前,微创组患者IL-6、CRP、PCT水平均低于常规组,IgA、IgG水平均高于常规组,差异均有统计学意义(P﹤0.05)。结论 胸腹腔镜联合Ivor Lewis食管癌根治术可促进食管癌患者术后恢复,改善患者免疫功能及肺功能,减轻患者炎症反应。

Objective To investigate the effects of thoracic laparoscopy combined with Ivor Lewis radical resection for esophageal cancer on lung function,serum inflammatory factors and immune function in patients with esophageal cancer.Method A total of 90 patients with esophageal cancer were divided into conventional group(46 cases) and minimally invasive group(44 cases) according to different surgical methods.The conventional group underwent thoracotomy Ivor Lewis radical esophagectomy,while the minimally invasive group underwent thoracic laparoscopy combined with Ivor Lewis radical esophagectomy.Perioperative related indexes,pulmonary function indexes [maximal voluntary ventilation(MVV),vital capacity(VC),forced expiratory volume in one second(FEV1)],serum inflammatory factors [C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)] and immune function indexes [immunoglobulin G(IgG),immunoglobulin A(IgA)] were compared between the two groups.Result The operation time and hospital stay in minimally invasive group were significantly shorter than those in conventional group,the number of lymph node dissection was significantly more than that in conventional group,and the intraoperative blood loss was significantly less than that in conventional group,the differences were statistically significant(P<0.01).One month after surgery,VC,MVV and FEV1in two groups were lower than those before surgery,and VC,MVV and FEV1in minimally invasive group were higher than those in conventional group,the differences were statistically significant(P<0.05).Three days after surgery,the levels of IL-6,CRP,PCT,IgA and IgG were higher than those before surgery,the levels of IL-6,CRP and PCT in minimally invasive group were lower than those in conventional group,and the levels of IgA and IgG were higher than those in conventional group,the differences were statistically significant(P<0.05).Conclusion Thoracic laparoscopy combined with Ivor Lewis radical resection of esophageal cancer can promote postoperative recovery of patients with esophageal cancer,improve the immune function and lung function,and reduce the inflammatory response.