胸腹腔镜下Ivor-lewis手术治疗Siewert Ⅱ型食管胃交界部腺癌的临床疗效  

Clinical effect of Ivor-lewis surgery under thoracolaparoscopy for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction region

作　　者：李德冰 张克[1] 梁少杰 LI De-bing;ZHANG Ke;LIANG Shao-jie(Department of Thoracic Surgery,First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan,CHINA)

机构地区：[1]河南科技大学第一附属医院胸外科,河南洛阳471000

出　　处：《海南医学》2023年第17期2484-2488,共5页Hainan Medical Journal

基　　金：河南省科技攻关项目(编号:222400420268)。

摘　　要：目的探究胸腹腔镜下Ivor-lewis手术治疗Siewert Ⅱ型食管胃交界部腺癌(AEGⅡ)患者的临床疗效。方法选取2020年1月至2022年1月河南科技大学第一附属医院收治的120例AEGⅡ患者纳入研究,采用随机数表法分为开胸组(实施开放手术)和微创组(实施胸腹腔镜下Ivor-lewis手术)各60例。比较两组患者的手术相关指标、术后各时间视觉模拟量表(VAS)评分、手术前后细胞免疫功能[淋巴细胞CD3^(+)、CD4^(+)、CD8^(+)]、肿瘤标志物[抗原细胞角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)、糖类抗原199(CA199)],同时比较两组患者的并发症情况及术后1年复发情况。结果微创组患者的手术时间、清扫淋巴结数目分别为(239.58±42.35)min、(34.58±7.82)个,明显长(多)于开胸组的(195.46±40.37)min、(25.62±7.31)个,术中总出血量、胃管拔出时间和住院天数分别为(155.84±21.55)mL、(8.15±1.79)d、(12.29±2.15)d,明显少于开胸组的(194.72±25.74)m L、(10.39±1.84)d、(15.44±2.48)d,差异均有统计学意义(P<0.05);术后24 h、72 h,微创组患者的VAS评分分别为(5.94±1.24)分、(2.15±0.63)分,明显低于开胸组的(6.85±1.23)分、(3.44±0.74)分,差异均有统计学意义(P<0.05);微创组患者术后3 d的CD3^(+)、CD4^(+)水平分别为(49.57±2.98)%、(33.95±1.89)%,术后7 d分别为(53.29±3.17)%、(35.22±1.86)%,明显高于开胸组术后3 d的(46.38±3.21)%、(31.77±1.83)%和术后7 d的(51.83±2.95)%、(33.71±1.95)%,差异均有统计学意义(P<0.05);微创组患者术后3 d和7 d的CD8^(+)水平分别为(28.74±2.19)%、(26.92±1.49)%,明显低于开胸组的(30.25±2.04)%、(27.54±1.62)%,差异均有统计学意义(P<0.05);微创组患者术后6个月的CYFRA21-1、CEA、CA199水平分别为(2.38±0.26)ng/mL、(3.27±0.45)ng/mL、(27.83±2.19)U/mL,术后12个月分别为(2.45±0.32)ng/mL、(3.35±0.44)ng/mL、(28.57±2.21)U/mL,明显低于开胸组术后6个月的(2.53±0.29)ng/mL、(3.51±0.41)ng/mL、(29.01±1.98)U/mLObjective To investigate the clinical effect of Ivor-lewis surgery under thoracolaparoscopy for Siewert type Ⅱ adenocarcinoma of the esophagogastric junction region(AEGⅡ).Methods A total of 120 AEGⅡ patients admitted to the First Affiliated Hospital of Henan University of Science and Technology from January 2020 to January 2022 were randomly divided into two groups.Sixty patients in the thoracotomy group underwent left thoracic approach surgery,while 60 patients in the minimally invasive group underwent thoracolaparoscopic Ivor-Lewis surgery.The two groups were compared in terms of surgical related indicators,Visual Analogue Scale(VAS)scores at various postoperative times,cellular immune function before and after surgery[lymphocyte(CD3^(+)),CD4^(+),CD8^(+)],tumor markers[antigenic cytokeratin 19 fragment antigen 21-1(CYFRA21-1),carcinoembryonic antigen(CEA),cancer antigen 199(CA199)],complications,and 1-year postoperative recurrence.Results Surgical time,more lymph nodes cleaned in the minimally invasive group were(239.58±42.35)min,34.58±7.82,significantly longer/more than(195.46±40.37)min,25.62±7.31 in the thoracotomy group;and the total intraoperative bleeding volume,gastric tube extraction time,and length of hospital stay were(155.84±21.55)mL,(8.15±1.79)d,(12.29±2.15)d,significantly less/shorter than(194.72±25.74)mL,(10.39±1.84)d,and(15.44±2.48)d in the thoracotomy group(P<0.05);the VAS scores of the minimally invasive group at 24 h and 72 h after surgery were(5.94±1.24)points and(2.15±0.63)points,respectively,significantly lower than(6.85±1.23)points and(3.44±0.74)points in the thoracotomy group(P<0.05).The levels of CD3^(+),CD4^(+)in the minimally invasive group were(49.57±2.98)%,(33.95±1.89)% at 3 days after surgery and(53.29±3.17)%,(35.22±1.86)% at 7 days after surgery,which were significantly higher than(46.38±3.21)%,(31.77±1.83)% at 3 days after surgery and(51.83±2.95)%,(33.71±1.95)% at 7 days after surgery in the thoracotomy group;the CD8^(+)levels were(28.74±2.19)% and(26.9

关 键 词：胃腺癌 IVOR-LEWIS手术 开放手术 胸腹腔镜 细胞免疫功能 临床疗效 安全性 

分 类 号：R735.2[医药卫生—肿瘤]