胸腹腔镜分别联合两种微创术式治疗早期中下段食管癌的近期疗效及对氧化应激肺功能的影响  

Two laparoscopic-thoracoscopic minimally invasive procedures in the treatment of early mid-and lower esophageal cancer: short-term outcomes and effects on oxidative stress and lung function

作　　者：陈晓冬[1] 宋永明 Chen Xiaodong;Song Yongming(Department of Thoracic Surgery,Shanxi Cancer Hospital,Taiyuan030013,China)

机构地区：[1]山西省肿瘤医院胸外科,太原030013

出　　处：《中国药物与临床》2020年第14期2316-2320,共5页Chinese Remedies & Clinics

摘　　要：目的探讨胸腹腔镜分别联合2种微创术式治疗早期中下段食管癌的临床效果。方法采用随机数字表法,将2017年7月至2019年7月收治的82例早期中下段食管癌患者予以分组,对照组40例,采用胸腹腔镜下Mc Keown术(MIME)治疗;观察组42例,采用胸腹腔镜下Lvor-Lewis术(MILE)治疗,对2组围术期指标,手术前、后氧化应激指标、肺功能变化及并发症情况予以观察。结果 2组喉返神经旁淋巴结与胸腔淋巴结清扫数量、术中出血量、引流管留置时间对比,差异无统计学意义(P>0.05),观察组手术时间、住院时间与对照组对比,明显较短(P<0.05);术前,总超氧化物歧化酶(T-SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)对比,差异无统计学意义(P>0.05),术后24 h,观察组上述指标情况与同期对照组对比,显著较好(P<0.05);术前,2组第1秒用力呼气容积(EFV1)与用力肺活量(FVC)比值、FEV1%预计值(FEV1%)对比,差异无统计学意义(P>0.05),术后1周,观察组上述指标水平与同期对照组对比,显著较高(P<0.05);2组乳糜胸、胃排空障碍发生率对比,差异无统计学意义(P>0.05),观察组肺部感染、吻合口瘘、喉返神经损伤发生率与对照组对比,明显较低(P<0.05)。结论胸腹腔镜联合MILE或MIME治疗早期中下段食管癌,近期疗效相当,但MILE手术时间更短,对患者氧化应激和肺功能影响小,且并发症较少,术后恢复较快,值得推广。Objective To investigate the clinical outcomes with two laparoscopic-thoracoscopic minimally invasive procedures in the treatment of early mid-and lower esophageal cancer. Methods Using random number table,82 patients with early mid-and lower esophageal cancer admitted to our hospital between July 2017 and July 2019 were divided into two groups: the control group(n=40) to undergo laparoscopic-thoracoscopic minimally invasive McKeown esophagectomy(MIME), and the study group(n=42) to undergo laparoscopic-thoracoscopic minimally invasive Lvor-Lewis esophagectomy(MILE). The perioperative indicators, oxidative stress, lung function and complications before and after surgery in the both groups were recorded. Results There were no significant differences in the numbers of dissection for recurrent laryngeal nerve lymph nodes and thoracic lymph nodes, intraoperative blood loss, and indwelling time of drainage tube between the two groups(P> 0.05). The operation time and length of hospital stay in the study group were significantly shorter than those in the control group(P<0.05). Before operation, there were no significant differences in total superoxide dismutase(T-SOD), glutathione peroxidase(GSH-Px) and malondialdehyde(MDA) between the two groups(P> 0.05). At 24 hours after surgery, these indicators were significantly improved compared with the control group(P<0.05). Before surgery, there were no significant differences in the ratio of forced expiratory volume in 1 second(FEV1) to forced vital capacity(FVC),and FEV1% predicted(FEV1%) between the two groups(P>0.05). At one week after surgery, these indicators were significantly higher in the study group than those in the control group(P<0.05). After surgery, there was no significant difference in the incidence of chylothorax and impaired gastric emptying between the two groups(P>0.05). The study group experienced significantly less pulmonary infection, anastomotic leakage, and recurrent laryngeal nerve injury, compared with the control group(P<0.05). Conclusion Laparoscop

关 键 词：胸腹腔镜 McKeown术 Lvor-Lewis术 食管肿瘤 氧化性应激 肺功能 

分 类 号：R735.1[医药卫生—肿瘤]