局部晚期食管鳞癌患者经左颈-右胸-腹三切口食管癌根治术(胸腹腔镜)与Ivor�Lewis(胸腹腔镜)术治疗的效果对比分析

Comparative analysis of the efficacy of radical esophagectomy(thoracoscopy)and Ivor-Lewis(thoracoscopy)for patients with locally advanced esophageal squamous cell carcinoma through left cervical-right thoracic-abdominal three incisions

目的:对比经左颈-右胸-腹三切口食管癌根治术(胸腹腔镜)、经腹胸二切口食管癌根治术(Ivor-Lewis esophagectomy,Ivor-Lewis)(胸腹腔镜)治疗局部完全食管鳞癌患者效果。方法:选取2018年5月至2023年5月期间在我院确诊的100例局部晚期食管鳞癌患者作为研究对象,依据治疗方案分为对照组和研究组,各50例。对照组接受胸腹腔镜联合Ivor-Lewis术,研究组接受胸腹腔镜联合左颈-右胸-腹三切口食管癌根治术。对比2组手术指标、并发症状况以及围术期免疫功能、应激反应[C反应蛋白(C reactive protein,CRP)、皮质醇(Cortisol,Cor)]、肠道功能(二胺氧化酶、D-乳酸)。结果:和对照组相比,研究组住院时间、术中失血量、首次进食时间、手术时间明显较少,淋巴结清扫数明显较多(P<0.05)。术后3 d,研究组血清二胺氧化酶、D-乳酸、CRP与Cor水平明显低于对照组(P<0.05);研究组CD4^(+)、CD4^(+)/CD8^(+)明显高于对照组(P<0.05)。研究组并发症发生率明显低于对照组(P<0.05)。结论:较胸腹腔镜联合Ivor-Lewis术,胸腹腔镜联合左颈-右胸-腹三切口食管癌根治术治疗局部晚期食管鳞癌患者效果显著,可改善手术效果,促进肠道功能恢复,减轻应激反应,对免疫功能影响较小,并能保障手术安全性。

Objective:To compare the efficacy of radical resection for locally advanced esophageal squamous cell carcinoma through three incisions(left cervical,right thoracic,and abdominal)(thoracoscopic surgery)and two incisions(abdominal and thoracic)(Ivor-Lewis esophagectomy)(thoracoscopic surgery).Methods:A total of 100 patients with locally advanced esophageal squamous cell carcinoma diagnosed in our hospital from May 2018 to May 2023 were selected as the research subjects.They were divided into a control group and a research group according to the treatment plan,with 50 cases in each group.The control group received thoracoscopic-laparoscopic combined Ivor-Lewis surgery,while the research group received thoracoscopic-laparoscopic combined left cervical-right chest-abdominal three-incision radical esophagectomy.Surgical indexes and complication status,as well as perioperative immune function,stress response[C reactive protein(CRP),cortisol(Cor)],and intestinal function(diamine oxidase,D-lactate)were compared between the 2 groups.Results:Compared with the control group,the study group had significantly less hospitalization time,intraoperative blood loss,first meal time,and operation time,and significantly more lymph node dissection(P<0.05).Three days after surgery,the serum levels of diamine oxidase,D-lactate,CRP,and Cor in the study group were significantly lower than those in the control group(P<0.05);the CD4+,CD4+/CD8^(+)in the study group were significantly higher than those in the control group(P<0.05).The incidence of complications in the study group was significantly lower than that in the control group(P<0.05).Conclusion:Compared with thoracoscopic and laparoscopic combined with Ivor-Lewis surgery,thoracoscopic and laparoscopic combined with left cervical-right chest-abdominal three-incision radical resection for the treatment of locally advanced esophageal squamous cell carcinoma patients has significant effects,which can improve surgical outcomes,promote intestinal function recovery,reduce stress response,have less impact on immune function,and ensure surgical safety.