胸腹腔镜联合与右胸三切口入路食管癌根治术后应激反应、免疫功能和远期疗效对比研究

Comparative study of stress response,immune function and long⁃term effect of thoracic laparoscopy combined with right thoracic three⁃incision radical resection of esophageal cancer

目的对比研究经胸腹腔镜联合食管癌根治术与右胸三切口入路食管癌根治术治疗中段食管癌的术后应激反应、免疫功能、并发症和远期疗效。方法选取2017年3月至2020年3月于徐州市第一人民医院就诊的病灶位于胸中段者食管癌患者为研究对象,将经胸腹腔镜联合食管癌根治手术治疗的患者纳入研究1组(50例),右胸三切口入路食管癌根治术的患者归为研究2组(50例),比较两组临床相关指标水平、术后应激反应、免疫功能改善情况、并发症发生率。另对两组患者均进行1年的随访,比较远期预后。结果研究1组手术时间、术后拔管时间、肛门排气时间、排便时间及住院时间均短于研究2组,术中出血量、术后引流量及术后疼痛度评分均低于研究2组(P<0.05);术后1 d,两组患者血清中肾上腺素(AD)、皮质醇(COR)水平均较术前升高(P<0.05);术后3 d,两组患者血清中AD、COR水平较术后1 d降低(P<0.05);研究1组术后1 d及3 d,血清中AD、COR水平均低于研究2组(P<0.05);术后1周,两组血清T淋巴细胞表面抗原CD4(CD4^(+))、CD4^(+)/T淋巴细胞表面抗原CD8(CD8^(+))水平均较术前升高,CD8^(+)较术前降低(P<0.05);术后1周,研究1组血清CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平与研究2组比较,差异无统计学意义(P>0.05);研究1组并发症发生率为8.00%,低于研究2组26.00%(P<0.05);经1年的随访发现,两组死亡率比较,差异无统计学意义(P>0.05)。结论食管癌患者应用上述两种手术方式均可达到治疗目的,改善免疫功能,远期预后可观。但相较右胸三切口入路食管癌根治手术,经胸腹腔镜食管癌根治手术应激反应更小,治疗时间及康复时间更短,并发症发生率更低。

Objective To compare the postoperative stress response,immune function,complications and longterm prognosis of middle thoracic esophageal cancer treated by transthoracic laparoscopy combined with radical resection of esophageal cancer and right thoracic three⁃incision approach.Methods A total of 100 patients with esophageal cancer who were treated in Xuzhou No.1 Peoples Hospital from March 2017 to March 2020 with focal locations in the middle chest segment were selected as study objects 50 patients who were treated by thoracic laparoscopy combined with radical resection of esophageal cancer were included in study group 1,and the other 50 patients who were treated by radical resection of esophageal cancer through right thoracic three⁃incision approach were classified into study group 2.The level of clinical indicators,the degree of postoperative stress reaction,the improvement of immune function,and the incidence of complications were compared between the two groups.Patients in both groups were followed up for one year to compare the long⁃term prognosis.Results The operative time,postoperative extubation time,anal exhaust time,defecation time,and hospital stay of study group 1 were all shorter than those of study group 2,and the intraoperative blood loss,postoperative drainage volume and postoperative pain scores were all lower than those of study group 2(P<0.05).On the first day after operation,the serum Adrenaline(AD)and Cortisol(COR)levels in both groups were significantly higher than those before operation(P<0.05).The levels of AD and COR in serum of both groups were significantly decreased 3 days after surgery compared with 1 day after surgery(P<0.05).The levels of AD and COR in serum of study group 1 were lower than those of study group 2 at 1 day and 3 days after operation(P<0.05).One week after operation,serum T lymphocyte surface antigen CD4(CD4^(+))and CD4^(+)/serum T lymphocyte surface antigen CD8(CD8^(+))levels in both groups were higher than those before operation,and CD8^(+)levels were lower than those before operation(P<0.05).One week after operation,there was no statistical significance in serum CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)levels between study group 1 and study group 2(P>0.05).The complication rate of study group 1 was 8.00%,which was lower than that of study group 2(26.00%)(P<0.05).After 1 year follow⁃up,there was no significant difference in mortality between the two groups(P>0.05).Conclusions In patients with esophageal cancer,the above two surgical methods can achieve the therapeutic purpose,improve the immune function,and achieve a good long⁃term prognosis.However,compared with the right thoracic three⁃incision approach radical surgery for esophageal cancer,transthoracic laparoscopic radical surgery for esophageal cancer has less stress reaction,shorter treatment time and recovery time,and lower complication rate.