[1]樊宏哲,郭　浩,杜鹏程.胸腔镜食管癌根治术联合左侧颈部吻合术治疗食管癌疗效观察[J].新乡医学院学报,2022,39(5):439-444.[doi:10.7683/xxyxyxb.2022.05.008]
　FAN Hongzhe,GUO Hao,DU Pengcheng.Curative effect of thoracoscopic radical resection of esophageal cancer combined with left neck anastomosis in the treatment of esophageal cancer[J].Journal of Xinxiang Medical University,2022,39(5):439-444.[doi:10.7683/xxyxyxb.2022.05.008]
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胸腔镜食管癌根治术联合左侧颈部吻合术治疗食管癌疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年5
页码:
439-444
栏目:
临床研究
出版日期:
2022-05-05

文章信息/Info

Title:
Curative effect of thoracoscopic radical resection of esophageal cancer combined with left neck anastomosis in the treatment of esophageal cancer
作者:
樊宏哲1; 郭　浩2; 杜鹏程3
（1.新乡医学院第三附属医院心胸外科，河南　新乡　453003；2.新乡医学院第三附属医院重症医学科，河南　新乡　453003；3.新乡医学院第三附属医院消化科，河南　新乡　453003）
Author(s):
FAN Hongzhe1; GUO Hao2; DU Pengcheng3
(1.Department of Cardiothoracic Surgery,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;2.Department of Intensive Care Medicine,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;3.Department of Gastroenterology,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China)
关键词:
胸腔镜食管癌根治术; 左侧颈部吻合术; 食管癌; 肺功能; 一氧化氮合成酶; 癌胚抗原; 可溶性白细胞介素-2受体
Keywords:
thoracoscopic radical resection of esophageal cancer; left neck anastomosis; esophageal cancer; lung function; nitric oxide synthase; carcinoembryonic antigen; soluble interleukin-2 receptor
分类号:
R735.1
DOI:
10.7683/xxyxyxb.2022.05.008
文献标志码:
A
摘要:
目的　探讨胸腔镜食管癌根治术联合左侧颈部吻合术治疗食管癌的临床效果。方法　选择2018年1 月至2020年12月新乡医学院第三附属医院收治的80例食管癌患者为研究对象，根据手术方法将患者分为对照组（n=38）和观察组（n=42）。对照组患者行常规经右胸食管癌切除术联合胃食管胸内吻合术治疗，观察组患者行胸腔镜食管癌根治术联合左侧颈部吻合术治疗。记录2组患者术中出血量、手术时间、淋巴结清扫个数、拔管时间、总引流量、住院时间。分别于术前及术后12、24、48、72 h，采用视觉模拟评分（VAS）评估患者疼痛情况。分别于术前、术后4周，采用肺功能仪检测患者肺功能相关指标，包括第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、肺活量（VC）、最大通气量（MVV），并计算FEV1/FVC。分别于术前、术后4周，采用酶联免疫吸附法检测患者血清中一氧化氮合酶（NOS）、可溶性白细胞介素-2受体（SIL-2R）水平，采用放射免疫分析法检测患者血清中癌胚抗原（CEA）水平。记录2组患者术后并发症发生情况。结果　2组患者淋巴结清扫个数比较差异无统计学意义（P>0.05）；观察组患者术中出血量、总引流量显著少于对照组，拔管时间、住院时间显著短于对照组，手术时间显著长于对照组（P<0.05）。术前2组患者的VAS评分比较差异无统计学意义（P>0.05）；2组患者术后12、24、48、72 h VAS评分呈下降趋势（P<0.05）；2组患者术后12、24、48、72 h VAS评分均显著低于术前（P<0.05）；术后12、24、48、72 h，观察组患者的 VAS评分均显著低于对照组（P<0.05）。术前2组患者的VC、MVV、FEV1、FEV1/FVC比较差异均无统计学意义（P>0.05）； 2组患者术后4周的VC、MVV、FEV1、FEV1/FVC均显著低于术前（P<0.05）；术后4周，观察组患者的VC、MVV、FEV1、FEV1/FVC均显著高于对照组（P<0.05）。术前2组患者血清NOS、CEA、SIL-2R水平比较差异无统计学意义（P>0.05）；2组患者术后4周血清NOS、CEA、SIL-2R水平均显著低于术前（P<0.05）；术后4周，观察组患者的血清NOS、CEA、SIL-2R水平均显著低于对照组（P<0.05）。观察组患者并发症发生率显著低于对照组（χ2=8.590，P<0.05）；观察组患者切口感染发生率显著低于对照组（χ2=4.654，P<0.05）；2组患者乳糜胸、吻合口漏、心律失常、喉返神经损伤、肺部感染发生率比较差异无统计学意义（χ2=0.011、0.611、0.956、0.066、0.664，P>0.05）。结论　与常规经右胸食管癌切除术联合胃食管胸内吻合术治疗食管癌相比，胸腔镜食管癌根治术联合左侧颈部吻合术虽然手术操作时间较长，但患者术中出血量、术后总引流量较少，术后患者疼痛更轻，且患者住院时间较短、恢复较快，术后肺功能损伤小，血清NOS、CEA、SIL-2R水平降低，术后切口感染的发生率较低。
Abstract:
Objective　To investigate the curative effect of thoracoscopic radical resection of esophageal cancer combined with left neck anastomosis in the treatment of esophageal cancer.Methods　Eighty patients with esophageal cancer admitted to the Third Affiliated Hospital of Xinxiang Medical University from January 2018 to December 2020 were selected as the research objects,and the patients were divided into the control group (n=38) and the observation group (n=42) according to the surgical methods.The patients in the control group were treated with conventional right thoracic esophagectomy combined with gastroesophageal anastomosis,and the patients in the observation group were treated with thoracoscopic radical esophagectomy combined with left neck anastomosis.The intraoperative blood loss,operation time,the number of removed lymph nodes,extubation time,total drainage volume and hospital stay time of patients in the two groups were recorded.The pain status of patients was evaluated by visual analogue scale (VAS) before operation and at 12,24,48,72 hours after operation.Before operation and 4 weeks after operation,pulmonary function-related indicators of patients were detected by spirometer,including forced expiratory volume in one second (FEV1),forced vital capacity (FVC),vital capacity (VC),maximum voluntary ventilation (MVV),and the FEV1/FVC was calculated.Before operation and 4 weeks after operation,the levels of serum nitric oxide synthase (NOS),soluble interleukin-2 receptor (SIL-2R) were detected by enzyme linked immunosorbent assay,and the level of carcinoembryonic antigen (CEA) in serum was detected by radioimmunoassay.The incidence of postoperative complications of patients in the two groups was recorded.Results　There was no significant difference in the number of removed lymph nodes of patients between the two groups (P>0.05);the intraoperative blood loss and the total drainage volume of patients in the observation group were significantly lower than those in the control group (P<0.05);the extubation time and the hospital stay time of patients in the observation group were significantly shorter than those in the control group,and the operation time of patients in the observation group was significantly longer than that in the control group(P<0.05).There was no significant difference in the VAS scores of patients between the two groups before operation (P>0.05);the VAS scores of patients in the two groups showed a downward trend at 12,24,48 and 72 hours after operation (P<0.05);the VAS scores of patients at 12,24,48,72 hours after operation were significantly lower than those before operation in the two groups (P<0.05);at 12,24,48,72 hours after operation,the VAS scores of patients in the observation group were significantly lower than those in the control group (P<0.05).There was no significant difference in the VC,MVV,FEV1 and FEV1/FVC of patients between the two groups before operation (P>0.05);the VC,MVV,FEV1 and FEV1/FVC of patients at 4 weeks after operation were significantly higher than those before operation in the two groups (P<0.05);at 4 weeks after operation,the VC,MVV,FEV1,FEV1/FVC of patients in the observation group were significantly higher than those in the control group (P<0.05).There was no significant difference in the NOS,CEA and SIL-2R levels in serum of patients between the two groups before operation (P>0.05);the NOS,CEA and SIL-2R levels in serum of patients at 4 weeks after operation were significantly lower than those before operation in the two groups (P<0.05);at 4 weeks after operation,the NOS,CEA and SIL-2R levels in serum of patients in the observation group were significantly lower than those in the control group (P<0.05).The incidence of complications of patients in the observation group was significantly lower than that in the control group (χ2=8.590,P<0.05);the incidence of incision infection of patients in the observation group was significantly lower than that in the control group (χ2=4.654,P<0.05);there was no significant difference in the incidence of anastomotic leakage,arrhythmia,recurrent laryngeal nerve injury and pulmonary infection of patients between the two groups (χ2=0.011,0.611,0.956,0.066,0.664;P>0.05).Conclusion　Compared with conventional right thoracic esophagectomy combined with gastroesophageal thoracic anastomosis for esophageal cancer,thoracoscopic radical esophagectomy combined with left neck anastomosis has a longer operative time,but the intraoperative blood loss,total postoperative drainage volume are significantly lower,the pain of patients after surgery is lighter,the hospitalization time of patients is shorter and the recovery is faster,which can reduce the damage to lung function caused by surgery,reduce the levels of serum NOS,CEA and SIL-2R,and reduce the postoperative incision infection rate.

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更新日期/Last Update: 2022-05-05