经左胸后外侧微创切口入路食管癌根治术对患者术后康复及血清炎症因子水平的影响  

Effect of Minimally Invasive Incision on the Postoperative Recovery and Serum Inflammatory Cytokine Levels in Patients Undergoing Radical Esophagectomy for Esophageal Cancer Through the Left Posterior Lateral Thoracic Incision

作　　者：宁妍妍 丁倩 杨慧 李敏 NING Yanyan;DING Qian;YANG Hui;LI Min(Department of Thoracic Surgery,Henan Provincial People’s Hospital,Henan Provincial Key Medical Nursing Laboratory,Zhengzhou University People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院胸外科,河南省重点医学护理实验室,郑州大学人民医院,河南郑州450003

出　　处：《河南医学研究》2024年第2期244-248,共5页Henan Medical Research

基　　金：2021年河南省医学科技攻关计划联合共建项目(LHGJ20210043)。

摘　　要：目的探究经左胸后外侧微创切口入路食管癌(EC)根治术治疗EC患者的效果及对术后康复及血清炎症因子水平的影响。方法选取医院2021年1月至2023年2月收治的82例EC患者,随机分成A组(41例)、B组(41例)。B组接受双切口入路(右胸-上腹部)EC根治术治疗,A组接受经左胸后外侧微创切口入路EC根治术治疗。对比两组手术指标、肺功能[用力肺活量(FVC)、肺活量(VC)、最大通气量(MVV)]、疼痛介质[P物质(SP)、前列腺素E2(PGE-2)、神经肽Y(NPY)]水平、炎症因子[肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平、并发症发生率。结果两组淋巴结清扫个数差异无统计学意义(P>0.05)。A组术中失血量较B组少,手术及住院耗时较B组短(P<0.05)。术后3个月两组FVC、VC、MVV水平降低,且A组低于B组(P<0.05)。术后3 d两组血清SP、NPY、PGE-2、TNF-α、PCT、IL-6、CRP水平升高,且B组水平高于A组(P<0.05)。A组并发症发生率低于B组(P<0.05)。结论双切口入路(右胸-上腹部)EC根治术与经左胸后外侧微创切口入路EC根治术治疗EC患者清扫淋巴结效果相当,但前者对机体肺功能影响更小,后者更有助于优化手术指标,减少并发症,减轻疼痛感,且对机体炎症应激反应影响更小。Objective To explore the efficacy of radical resection of esophageal cancer(EC)through left posterolateral minimally invasive incision and its effect on postoperative rehabilitation and serum inflammatory factors.Methods A total of 82 EC patients admitted to the hospital from January 2021 to February 2023 were randomly divided into group A(41 cases)and group B(41 cases).Group B received dual incision(right chest upper abdomen)EC radical surgery,while group A received EC radical surgery through a minimally invasive incision on the posterior lateral side of the left chest.The surgical indexes,lung function[forced vital capacity(FVC),vital capacity(VC),maximal voluntary ventilation(MVV)],pain mediators[substance P(SP),prostaglandin E2(PGE-2),neuropeptide Y(NPY)],inflammatory factors[tumor necrosis factor-α(TNF-α),procalcitonin(PCT)],[interleukin-6(IL-6),C-reactive protein(CRP)]levels,complication rate were compared between the two groups.Results There was no statistically difference in the number of lymph node dissection between the two groups(P>0.05).The intraoperative blood loss in group A was lower than that in group B,and the surgical and hospitalization time was shorter than that in group B(P<0.05).Three months after surgery,the levels of FVC,VC,and MVV in both groups decreased,and the levels in group A was lower than in group B(P<0.05).Three days after surgery,the levels of two groups of serum SP,NPY,PGE-2,TNF-a,PCT,IL-6,and CRP increased,and the levels in group B were higher than those in group A(P<0.05).The incidence of complications in group A was lower than that in group B(P<0.05).Conclusion Two-incision EC radical resection(right thoracie-upper abdomen)has the same efficacy as minimally invasive EC radical resection via left posterolateral thoracie incision for lymph node dissection in EC patients,but the former has less impact on lung function,while the latter is more helpful to optimize surgical indicators,reduce complications,relieve pain,and have less impact on inflammatory stress response.

关 键 词：食管癌 炎症因子 肺功能 疼痛介质 

分 类 号：R735.1[医药卫生—肿瘤]