胸腔镜食管癌根治术对食管癌患者术后创伤应激、免疫功能及微转移的影响  

Effects of thoracoscopic radical resection of esophageal cancer on postoperative traumatic stress, immune function and micrometastasis

作　　者：赵强[1] 连长红[1] 和源 王梁 徐延均 路清蒲[1] Zhao Qiang;Lian Changhong;He Yuan;Wang Liang;Xu Yanjun;Lu Qingpu(Department of General Surgery,Changzhi Medical College Affiliated Peace Hospital,Changzhi 046000,China)

机构地区：[1]长治医学院附属和平医院普外科,山西长治046000

出　　处：《中国实用医刊》2019年第17期23-27,共5页Chinese Journal of Practical Medicine

基　　金：2016年度长治医学院科技启动基金项目(201603).

摘　　要：目的探讨胸腔镜食管癌根治术对食管癌患者术后创伤应激、免疫功能及微转移的影响。方法选择2016年10月至2018年10月长治医学院附属和平医院收治的食管癌患者98例为研究对象,根据患者手术方式将其分为腔镜组(n=49,接受胸腔镜食管癌根治术治疗)和开放组(n=49,接受开放食管癌根治术治疗)。比较两组患者手术时间等围术期观察指标、创伤应激相关指标[C反应蛋白(CRP)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)]、免疫功能(CD3^+、CD4^+、CD8^+)、微转移相关细胞因子[白细胞介素-1β(IL-1β)和高迁移率族蛋白B1(HMGB1)]。结果腔镜组患者术中出血量及术后拔管时间、住院时间均少于开放组(P<0.05),两组手术时间比较差异未见统计学意义(P>0.05)。术后1d,两组患者CRP较术前升高(P<0.05),FT3和FT4水平较术前降低(P<0.05),但两组术后1d的创伤应激指标比较差异均未见统计学意义(P均>0.05);术后1d,两组血清T细胞亚群(CD3^+、CD4^+、CD8^+)水平均降低(P均<0.05),但腔镜组术后1d的上述血清T细胞亚群水平高于开放组(P<0.05);术后7d,两组血清微转移相关细胞因子(IL-1β、HMGB1)高于术后3d(P<0.05),且腔镜组术后7d的IL-1β和HMGB1低于开放组(P<0.05)。结论胸腔镜食管癌根治术与开放食管癌根治术对患者的应激水平无明显差异,但前者对免疫功能、微转移情况影响较小,更有利于术后恢复。Objective To observe the effects of thoracoscopic radical resection of esophageal cancer on postoperative traumatic stress, immune function and micrometastasis. Methods A total of 98 patients with esophageal cancer admitted to Changzhi Medical College Affiliated Peace Hospital from October 2016 to October 2018 were selected for the study. According to the surgical methods, they were divided into thoracoscopic group (n=49, given thoracoscopic radical resection of esophageal cancer) and open group (n=49, given open radical resection of esophageal cancer). The perioperative indexes such as operative time, traumatic stress-related indicators, including C-reactive protein (CRP), free-triiodothyronine (FT3) and free thyroxine (FT4), immune function (CD3^+, CD4^+, CD8^+) and micrometastasis-associated cytokines including interleukin-1β(IL-1β) and high mobility group protein B1 (HMGB1), were compared between the two groups. Results The intraoperative blood loss and postoperative observation indexes (extraction time, hospital stay) in thoracoscopic group were significantly lower than those in open group (P<0.05), and there was no significant difference in the operative time between the two groups (P>0.05). CRP was significantly increased in the two groups 1 d after operation (P<0.05), while the FT3 and FT4 levels were significantly decreased (P<0.05), but there were no significant differences in the traumatic stress indexes between the two groups 1 d after operation (P>0.05). On 1 d after operation, the levels of serum T cell subsets (CD3^+, CD4^+, CD8^+) were significantly decreased in the two groups (P<0.05), but the above-mentioned serum T cell subsets in thoracoscopic group were higher than those in open group 1 d after operation (P<0.05). On 7 d after operation, the levels of serum micrometastasis-associated cytokines (IL-1β, HMGB1) were significantly increased in the two groups (P<0.05), and the levels of IL-1β and HMGB1 in thoracoscopic group 7 d after operation were lower than those in open group (P<0.05). Con

关 键 词：食管癌 胸腔镜食管癌根治术 开放食管癌根治术 应激 

分 类 号：R735.1[医药卫生—肿瘤]