右侧颈部吻合联合胸腹腔镜根治术对食管癌患者应激反应和PPCs发生率的影响  

Effects of Right Cervical Anastomosis Combined with Thoraco-laparoscopic Radical Resection on Stress Response and Incidence of PPCs in Patients with Esophageal Cancer

作　　者：王长青[1] 孙伟锋 顾天瑞[1] WANG Changqing;SUN Weifeng;GU Tianrui(Anyang District Hospital of Puyang,Anyang,455000)

机构地区：[1]河南省濮阳市安阳地区医院,455000

出　　处：《实用癌症杂志》2023年第11期1851-1854,1858,共5页The Practical Journal of Cancer

摘　　要：目的 探讨右侧颈部吻合联合胸腹腔镜根治术对食管癌患者应激反应和肺部并发症(PPCs)发生率的影响。方法 选取60例食管癌患者,根据其手术方式分为右侧吻合组(28例)和左侧吻合组(32例)。均在胸腹腔镜下进行食管癌根治术,右侧吻合组采用右侧颈部吻合,左侧吻合组采用左侧颈部吻合。比较两组患者围术期相关指标以及手术前后应激激素水平[C反应蛋白(CRP)、皮质醇(Cor)]、免疫功能(CD3^(+)、CD4^(+)/CD8^(+)、NK细胞)、炎性因子[肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)]、肺功能[用力肺活量占预计值百分比(FVC)、1 s用力呼气量与FVC比值(FEV1/FVC)、动脉血氧分压(PaO_(2))]及术后PPCs发生情况。结果 右侧吻合组与左侧吻合组手术时间、术中出血量、淋巴结清扫数目及术后首次排气时间、胃肠功能恢复时间、术后住院时间比较均无明显差异(P>0.05);两组术后CRP、Cor、TNF-α、IL-6水平较术前均有升高,术后CD3^(+)、CD4^(+)/CD8^(+)、NK细胞水平较术前均有降低,但两组比较均无明显差异(P<0.05);右侧吻合组术后FVC、FEV1/FVC高于左侧吻合组(P<0.05)。右侧吻合组肺炎和吻合口瘘发生率分别为7.14%和3.52%,均低于左侧吻合组的28.12%和21.88%(P<0.05)。结论 胸腹腔镜根治术对食管癌患者术中应激反应较小,联合右侧颈部吻合可以降低PPCs和吻合口瘘的发生率,值得临床推广。Objective To explore the effects of right cervical anastomosis combined with thoraco-laparoscopic radical resection on stress response and incidence of pulmonary complications(PPCs)in patients with esophageal cancer.Methods According to different surgical methods,60 patients with esophageal cancer were divided into right anastomosis group(28 cases,right cervical anastomosis)and left anastomosis group(32 cases,left cervical anastomosis).The perioperative related indexes,levels of stress hormones[C-reactive protein(CRP),cortisol(Cor)],immune function(CD3^(+),CD4^(+)/CD8^(+),NK cells),inflammatory factors[tumor necrosis factorα(TNF-α),interleukin-6(IL-6)]and pulmonary function[forced vital capacity(FVC),ratio of forced expiratory volume in 1s to FVC(FEV1/FVC),partial pressure of arterial oxygen(PaO_(2))]before and after surgery,and the occurrence of postoperative PPCs were compared between the 2 groups.Results The difference in operation time,intraoperative blood loss,number of dissected lymph nodes,postoperative first exhaust time,recovery time of gastrointestinal function and postoperative hospitalization time between the 2 group was not statistically significant(P>0.05).After surgery,levels of CRP,Cor,TNF-αand IL-6 were increased,while levels of CD3^(+),CD4^(+)/CD8^(+)and NK cells were decreased in both groups,but the difference between the 2 group was not statistically significant(P>0.05).After surgery,FVC and FEV1/FVC were higher in right anastomosis group than left anastomosis group(P<0.05).The incidences rates of pneumonia and anastomotic leakage in right anastomosis group were 7.14%and 3.52%,lower than 28.12%and 21.88%in left anastomosis group(P<0.05).Conclusion Thoraco-laparoscopic radical resection has little intraoperative stress response in patients with esophageal cancer,and which combined with right cervical anastomosis can reduce the incidence of PPCs and anastomotic leakage.

关 键 词：胸腹腔镜 右颈部吻合 食管癌 应激反应 肺部并发症 

分 类 号：R735.1[医药卫生—肿瘤]