经左胸入路和经腹入路手术治疗贲门癌对患者术后恢复的影响

Effect of Trans-Left-Chest and Transabdominal Surgeries on Postoperative Recovery of Patients with Cardiac Carcinoma

目的观察经左胸入路和经腹入路两种术式治疗贲门癌对患者术后恢复的影响。方法回顾性收集126例接受手术切除治疗的贲门癌患者临床资料,根据选择手术方式不同分为经左胸组(n=57)和经腹组(n=69);比较两组手术情况、术后恢复情况、术后并发症、手术前后T淋巴细胞亚群及术后1年复发、生存情况。结果经腹组较经左胸组手术时间、术中出血量均明显减少(P<0.05),而两组淋巴结清扫数目、切缘阳性率、根治性手术率比较差异无统计学意义(P>0.05)。与经左胸组比较,经腹组术后肛门排气时间、术后引流管拔除时间、术后1d、3d疼痛视觉模拟评分、术后住院时间均明显降低(P<0.05)。与经左胸组相比,经腹组肺部并发症及总并发症发生率均明显降低(P<0.05)。经腹组术后7d时T淋巴细胞亚群与术前比较,差异无统计学意义(P>0.05);经左胸组术后7d时CD_3^+、CD_4^+、CD_4^+/CD_8^+水平于术前相比均明显降低(P<0.05),且均明显低于经腹组(P<0.05)。两组术后1年复发率及生存率比较差异无统计学意义(P>0.05)。结论较之经左胸入路,经腹入路行贲门癌切除术能够促进患者术后恢复,减少肺部并发症,且对免疫功能影响小。

Objective To observe the effect of trans-left-chest and transabdominal surgeries on postoperative recovery of patients with cardiac carcinoma.Methods The clinical data of 126 patients with cardiac carcinoma who underwent surgical resection were retrospectively collected.They were divided into the trans-left-chest group(n=57)and the transabdominal group(n=69)according to different approaches.Surgical conditions,postoperative recovery,postoperative complications,T lymphocyte subsets before and after surgery,and recurrence and survival in 1 year after surgery were compared between the two groups.Results The surgical time and intraoperative blood loss in the transabdominal group were significantly shorter/less than those in the trans-left-chest group(P<0.05).There was no significant difference in the number of removed lymph nodes,positive rate of incisal margins or radical surgery rate between the two groups(P>0.05).The postoperative anal exhaustion time,postoperative drainage tube removal time,postoperative visual analogue scale scores at 1 day and 3 days after surgery and postoperative hospital stay in the transabdominal group were significantly shorter/lower than those in the trans-left-chest group(P<0.05).Compared with the trans-left-chest group,the incidence of pulmonary complications and overall incidence of complications were significantly lower in the transabdominal group(P<0.05).There was no significant change in T lymphocyte subsets in the transabdominal group at 7 days after surgery,compared with those before surgery(P>0.05).Levels of CD3+,CD4+and CD4+/CD8+were significantly decreased in the trans-left-chest group at the 7 days after surgery(P<0.05),and were significantly lower than those in the transabdominal group(P<0.05).There was no significant difference in the recurrence rate or survival rate between the two groups in 1 year after surgery(P>0.05).Conclusion Compared with the trans-leftchest approach,transabdominal resection of cardiac carcinoma can promote postoperative recovery and decrease pulmonary complications,with little effect on immune function.