胸腹腔镜手术治疗食管癌患者近期效果观察及对应激反应和炎性反应的影响  

The short-term effect of thoracoscopic radical esophagectomy for esophageal cancer and its effect on stress response and inflammatory response

作　　者：杨峥 赵炎[2] 樊卫[3] 朱悚之 曹恺祺 Yang Zheng;Zhao Yan;Fan Wei;Zhu Songzhi;Cao Kaiqi(Department of Emergency Medicine,Tongde Hospital of Zhejiang Province,Hangzhou 330009,China;Department of Thoracic Surgery,Huai′an Cancer Hospital,Jiangsu Huai′an 223200,China;Department of Laboratory,Huai′an Cancer Hospital,Jiangsu Huai′an 223200,China)

机构地区：[1]浙江省立同德医院急诊医学科,杭州330009 [2]江苏省淮安市肿瘤医院胸外科,223200 [3]江苏省淮安市肿瘤医院检验科,223200

出　　处：《中国医师进修杂志》2021年第6期487-491,共5页Chinese Journal of Postgraduates of Medicine

基　　金：江苏省淮安市卫生健康委员会面上项目(HAWJ201926)。

摘　　要：目的探讨胸腹腔镜手术治疗食管癌患者的近期效果及对应激反应和炎性反应的影响。方法选择浙江省立同德医院2018年3月至2020年3月收治的食管癌患者124例,其中62例患者采用胸腹腔镜手术治疗(观察组),62例患者采用传统开放食管癌根治术治疗(对照组)。比较两组围手术期指标变化、术后并发症发生情况、术前和术后第3天应激反应和炎性反应指标的变化、术前和术后1个月肺功能的变化。结果观察组术中出血量少于对照组[(189.52±37.28)ml比(258.94±32.14)ml],手术时间长于对照组[(271.92±25.43)min比(231.09±23.16)min],差异有统计学意义(t=11.105、9.347,P<0.05);而两组淋巴结清扫总数比较差异无统计学意义(t=1.295,P>0.05)。观察组术后并发症发生率低于对照组[9.68%(6/62)比24.19%(15/62)],差异有统计学意义(χ^(2)=4.644,P<0.05)。观察组术后第3天皮质醇(Cor)和去甲肾上腺素(NE)水平低于对照组[(145.32±12.39)μg/L比(197.56±18.78)μg/L、(84.54±5.98)μg/L比(98.93±7.26)μg/L],差异有统计学意义(t=18.283、12.047,P<0.05)。观察组术后第3天血清白细胞介素6(IL-6)、C反应蛋白和肿瘤坏死因子-α水平低于对照组[(101.31±6.56)μg/L比(149.09±12.31)μg/L、(18.94±4.53)mg/L比(29.95±4.16)mg/L、(84.52±5.89)ng/L比(109.32±8.64)ng/L],差异有统计学意义(t=26.972、14.096、18.675,P<0.05)。观察组术后1个月第1秒用力呼气容积(FEV_(1))占预计值百分比、FEV_(1)/用力肺活量高于对照组[(78.79±4.50)%比(72.16±3.64)%、(67.84±3.24)%比(60.39±4.15)%],差异有统计学意义(t=9.020、11.142,P<0.05)。结论胸腹腔镜手术治疗食管癌患者近期效果明显,且对应激反应、炎性反应和肺功能影响小。Objective To investigate the short-term effect of thoracoscopic and laparoscopic surgery in the treatment of esophageal cancer and its impact on stress response and inflammatory response.Methods The clinical data of 124 patients with esophageal cancer admitted to Huai′an Cancer Hospital from March 2018 to March 2020 were analyzed.The patients in observation group(62 cases)were treated with thoracoscopic esophagectomy and the patients in control group(62 cases)were treated with traditional open esophagectomy.The changes of perioperative indexes,postoperative complications,stress response,inflammatory response indexes before and 3 d after operation,and pulmonary function before and 1 month after operation were compared between the two groups.Results The intraoperative blood loss in the observation group was less than that in the control group:(189.52±37.28)ml vs.(258.94±32.14)ml;the operation time in the observation group was longer than that in the control group:(271.92±25.43)min vs.(231.09±23.16)min,and the differences were statistically significant(t=11.105,9.347,P<0.05).But there was no significant difference in the total number of lymph node dissection between the two groups(t=1.295,P>0.05).The postoperative complications in the observation group was less than that in the control group:9.68%(6/62)vs.24.19%(15/62),χ^(2)=4.644,P<0.05.The serum levels of cortisol and norepinephrine at 3 d after operation in the observation group were lower than those in the control group:(145.32±12.39)μg/L vs.(197.56±18.78)μg/L,(84.54±5.98)μg/L vs.(98.93±7.26)μg/L,and the differences were statistically significant(t=18.283,12.047,P<0.05).The serum levels of interleukin 6,C-reactive protein and tumor necrosis factoralpha at 3 d after operation in the observation group were lower than those in the control group:(101.31±6.56)μg/L vs.(149.09±12.31)μg/L,(18.94±4.53)mg/L vs.(29.95±4.16)mg/L,(84.52±5.89)ng/L vs.(109.32±8.64)ng/L,and the differences were statistically significant(t=26.972,14.096,18.675,P<0.05).The

关 键 词：胸腹腔镜手术 食管肿瘤 近期效果 应激反应 

分 类 号：R735.1[医药卫生—肿瘤]