全胸腔镜食管癌根治术对食管癌患者炎性反应及应激反应的影响
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摘要
目的探讨全胸腔镜食管癌根治术对食管癌患者炎性反应及应激反应的影响。方法选取2014年1月～2018年1月海南省人民医院收治的食管癌患者84例,并根据随机数字表法将其分为对照组(n=42)和研究组(n=42)。对照组给予开胸食管癌根治术,研究组给予全胸腔镜食管癌根治术。比较两组患者术后临床指标情况;比较两组患者术前、术后1周炎性反应指标[白细胞介素-6(IL-6)、IL-10以及肿瘤坏死因子-α(TNF-α)]、应激反应指标[C反应蛋白(CRP)、血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)以及皮质醇];观察两组患者术后并发症发生情况。结果研究组手术时间、术中失血量、术后引流量及住院时间均低于对照组(P <0.05);两组清扫淋巴结数目比较,差异无统计学意义(P> 0.05)。两组术后1周IL-6、IL-10以及TNF-α水平均较术前升高,且对照组高于研究组(P <0.05),两组术后1周CRP、FT3、FT4及皮质醇水平均较术前升高(P <005);但两组间比较,差异无统计学意义(P> 0.05)。两组术后并发症发生率比较,差异无统计学意义(P> 0.05)。结论与开胸食管癌根治术比较,全胸腔镜食管癌根治术可明显减轻食管癌患者炎性反应,且对机体应激反应、术后并发症发生情况无明显影响。
Objective To investigate the effect of total thoracic esophageal cancer radical surgery on inflammatory response and stress response in patients with esophageal cancer. Methods Eighty-four patients with esophageal cancer admitted to Hainan General Hospital from January 2014 to January 2018 were selected and divided into control group(n = 42) and research group(n = 42) according to the randon number table method. The control group was treated with open thoracic esophageal cancer radical surgery, the study group was treated with total thoracic esophageal cancer radical surgery. The clinical indexes of the two groups were compared. The inflammatory reaction indicators [interleukin-6(IL-6), IL-10, tumor necrosis factor-alpha(TNF-alpha)], stress response indicators [C-reactive protein(CRP), serum free triiodothyronine(FT3), free thyroxine(FT4) and cortisol] were observed before and one week after the operation. The postoperative complication of the two groups were observed. Results The operation time, intraoperative blood loss, postoperative drainage and hospitalization time in the study group were lower than those in the control group(P < 0.05);there was no significant difference in the number of lymph nodes between the two groups(P > 0.05). The levels of IL-6,IL-10 and TNF-α were higher in the control group than in the study group one week after operation(P < 0.05). The levels of CRP, FT3, FT4 and cortisol were higher in the two groups one week after operation(P < 0.05), but there was no significant difference between the two groups(P > 0.05). There was no significant difference in the incidence of complications between the two groups(P > 0.05). Conclusion Compared with open radical esophageal cancer, radical thoracoscopic radical esophagectomy can significantly reduce the inflammatory reaction in patients with esophageal cancer,and has no significant effect on the body′ s stress response and postoperative complications.
Objective To investigate the effect of total thoracic esophageal cancer radical surgery on inflammatory response and stress response in patients with esophageal cancer. Methods Eighty-four patients with esophageal cancer admitted to Hainan General Hospital from January 2014 to January 2018 were selected and divided into control group(n = 42) and research group(n = 42) according to the randon number table method. The control group was treated with open thoracic esophageal cancer radical surgery, the study group was treated with total thoracic esophageal cancer radical surgery. The clinical indexes of the two groups were compared. The inflammatory reaction indicators [interleukin-6(IL-6), IL-10, tumor necrosis factor-alpha(TNF-alpha)], stress response indicators [C-reactive protein(CRP), serum free triiodothyronine(FT3), free thyroxine(FT4) and cortisol] were observed before and one week after the operation. The postoperative complication of the two groups were observed. Results The operation time, intraoperative blood loss, postoperative drainage and hospitalization time in the study group were lower than those in the control group(P < 0.05);there was no significant difference in the number of lymph nodes between the two groups(P > 0.05). The levels of IL-6,IL-10 and TNF-α were higher in the control group than in the study group one week after operation(P < 0.05). The levels of CRP, FT3, FT4 and cortisol were higher in the two groups one week after operation(P < 0.05), but there was no significant difference between the two groups(P > 0.05). There was no significant difference in the incidence of complications between the two groups(P > 0.05). Conclusion Compared with open radical esophageal cancer, radical thoracoscopic radical esophagectomy can significantly reduce the inflammatory reaction in patients with esophageal cancer,and has no significant effect on the body′ s stress response and postoperative complications.
引文
[1]Fujita H.History of lymphadenectomy for esophageal cancer and the future prospects for esophageal cancer surgery[J].Surg Today,2015,45(2):140-149.
[2]傅剑华,谭子辉.食管癌外科治疗的现状与未来展望[J].中国肿瘤临床,2016,43(12):507-510.
[3]施庆彤.胸腔镜手术与开胸手术治疗食管癌疗效比较[J].山东医药,2015,55(42):61-62.
[4]Runkel N,Walz M,Ketelhut M.Abdominothoracic esophageal resection according to Ivor Lewis with intrathoracic anastomosis:standardized totally minimally invasive technique[J].Chirurg,2015,86(5):468-475.
[5]靳超.胸腹腔镜食管癌根治术在老年食管癌治疗中的应用价值[J].中国老年学杂志,2016,36(10):2413-2414.
[6]Suda K,Ishida Y,Kawamura Y,et al.Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position:technical report and short-term outcomes[J].World J Surg,2012,36(7):1608-1616.
[7]左婷婷,郑荣寿,曾红梅,等.中国食管癌发病状况与趋势分析[J].中华肿瘤杂志,2016,38(9):703-708.
[8]Hong D,Liu T,Huang W,et al.Gremlin1 Delivered by Mesenchymal Stromal Cells Promoted Epithelial-Mesenchymal Transition in Human Esophageal Squamous Cell Carcinoma[J].Cell Physiol Biochem,2018,47(5):1785-1799.
[9]毛友生,赫捷,章智荣,等.胸段食管癌经胸腔镜手术与常规开胸手术淋巴结清扫程度的比较[J].中华肿瘤杂志,2015,37(7):530-533.
[10]马明全,姜宏景,唐鹏,等.胸腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫情况的回顾性比较[J].中华胸心血管外科杂志,2015,31(5):260-263.
[11]刘贵廷,高克锋,杨那,等.全胸腔镜手术与传统开胸手术治疗食管癌的近期临床疗效比较[J].中国现代医生,2018,56(13):44-46.
[12]彭仕骏,蔡伟明,林晓竹,等.胸腔镜联合腹腔镜和开胸三切口食管癌根治术治疗食管癌的效果对比[J].中国医药科学,2017,7(3):169-171,178.
[13]Suda K,Ishida Y,Kawamura Y,et al.Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position:technical report and short-term outcomes[J].World J Surg,2012,36(7):1608-1616.
[14]纪沛君,张文峰,余操,等.胸腔镜联合腹腔镜治疗食管癌的临床效果观察[J].中国医药导报,2016,13(2):89-92,108.
[15]周海宁,朱允和,郭孟刚,等.胸腹腔镜食管癌切除术临床分析[J].中国现代医生,2017,55(15):49-51.
[16]吴君旭,张明军,石开虎,等.全腔镜与开放食管癌三野淋巴节清扫术的临床应用与分析[J].安徽医科大学学报,2015,50(7):1039-1041,1042.
[17]Archana A,Sureshkumar S,Vijayakumar C,et al.Comparing the Harmonic Scalpel with Electrocautery in Reducing Postoperative Flap Necrosis and Seroma Formation after Modified Radical Mastectomy in Carcinoma Breast Patients:A Double-Blind Prospective Randomized Control Trail[J].Cureus,2018,10(4):e2476.
[18]刘良,杨立信,徐志云,等.全胸腔镜食管癌根治术对患者术后肺功能及炎性因子的影响[J].海南医学院学报,2016,22(18):2136-2138,2142.
[19]宋琦.全胸腔镜手术与传统开胸手术治疗食管癌患者近期临床疗效比较[J].中华胸心血管外科杂志,2015,31(2):19-20.
[20]梁锐宇,梁锦崧,饶新辉,等.胸腹腔镜食管癌根治术与传统开放手术疗效的对比研究[J].中国医药科学,2018,8(9):227-229.
[21]臧豹,赵建强,侯予龙,等.食管癌微创与开放根治术在淋巴结清扫和术后早期并发症的对比研究[J].中国微创外科杂志,2016,16(3):205-208.
[22]鲁勇国,梅波,万志渝,等.胸腔镜食管癌切除术对术后肺部感染和炎症细胞因子的影响[J].重庆医学,2016,45(15):2122-2124.
[23]张国才,曾富春.不同食管癌根治术对患者术后肺功能、炎症因子及应激反应的影响[J].海南医学院学报,2016,22(16):1914-1917.
[24]周瑜,黄涛,傅勇,等.全胸腔镜下食管癌根治术对炎症因子及患者生存质量的影响研究[J].检验医学与临床,2014(18):2561-2562.
[2]傅剑华,谭子辉.食管癌外科治疗的现状与未来展望[J].中国肿瘤临床,2016,43(12):507-510.
[3]施庆彤.胸腔镜手术与开胸手术治疗食管癌疗效比较[J].山东医药,2015,55(42):61-62.
[4]Runkel N,Walz M,Ketelhut M.Abdominothoracic esophageal resection according to Ivor Lewis with intrathoracic anastomosis:standardized totally minimally invasive technique[J].Chirurg,2015,86(5):468-475.
[5]靳超.胸腹腔镜食管癌根治术在老年食管癌治疗中的应用价值[J].中国老年学杂志,2016,36(10):2413-2414.
[6]Suda K,Ishida Y,Kawamura Y,et al.Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position:technical report and short-term outcomes[J].World J Surg,2012,36(7):1608-1616.
[7]左婷婷,郑荣寿,曾红梅,等.中国食管癌发病状况与趋势分析[J].中华肿瘤杂志,2016,38(9):703-708.
[8]Hong D,Liu T,Huang W,et al.Gremlin1 Delivered by Mesenchymal Stromal Cells Promoted Epithelial-Mesenchymal Transition in Human Esophageal Squamous Cell Carcinoma[J].Cell Physiol Biochem,2018,47(5):1785-1799.
[9]毛友生,赫捷,章智荣,等.胸段食管癌经胸腔镜手术与常规开胸手术淋巴结清扫程度的比较[J].中华肿瘤杂志,2015,37(7):530-533.
[10]马明全,姜宏景,唐鹏,等.胸腔镜微创与开放食管癌根治术围手术期并发症和淋巴结清扫情况的回顾性比较[J].中华胸心血管外科杂志,2015,31(5):260-263.
[11]刘贵廷,高克锋,杨那,等.全胸腔镜手术与传统开胸手术治疗食管癌的近期临床疗效比较[J].中国现代医生,2018,56(13):44-46.
[12]彭仕骏,蔡伟明,林晓竹,等.胸腔镜联合腹腔镜和开胸三切口食管癌根治术治疗食管癌的效果对比[J].中国医药科学,2017,7(3):169-171,178.
[13]Suda K,Ishida Y,Kawamura Y,et al.Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position:technical report and short-term outcomes[J].World J Surg,2012,36(7):1608-1616.
[14]纪沛君,张文峰,余操,等.胸腔镜联合腹腔镜治疗食管癌的临床效果观察[J].中国医药导报,2016,13(2):89-92,108.
[15]周海宁,朱允和,郭孟刚,等.胸腹腔镜食管癌切除术临床分析[J].中国现代医生,2017,55(15):49-51.
[16]吴君旭,张明军,石开虎,等.全腔镜与开放食管癌三野淋巴节清扫术的临床应用与分析[J].安徽医科大学学报,2015,50(7):1039-1041,1042.
[17]Archana A,Sureshkumar S,Vijayakumar C,et al.Comparing the Harmonic Scalpel with Electrocautery in Reducing Postoperative Flap Necrosis and Seroma Formation after Modified Radical Mastectomy in Carcinoma Breast Patients:A Double-Blind Prospective Randomized Control Trail[J].Cureus,2018,10(4):e2476.
[18]刘良,杨立信,徐志云,等.全胸腔镜食管癌根治术对患者术后肺功能及炎性因子的影响[J].海南医学院学报,2016,22(18):2136-2138,2142.
[19]宋琦.全胸腔镜手术与传统开胸手术治疗食管癌患者近期临床疗效比较[J].中华胸心血管外科杂志,2015,31(2):19-20.
[20]梁锐宇,梁锦崧,饶新辉,等.胸腹腔镜食管癌根治术与传统开放手术疗效的对比研究[J].中国医药科学,2018,8(9):227-229.
[21]臧豹,赵建强,侯予龙,等.食管癌微创与开放根治术在淋巴结清扫和术后早期并发症的对比研究[J].中国微创外科杂志,2016,16(3):205-208.
[22]鲁勇国,梅波,万志渝,等.胸腔镜食管癌切除术对术后肺部感染和炎症细胞因子的影响[J].重庆医学,2016,45(15):2122-2124.
[23]张国才,曾富春.不同食管癌根治术对患者术后肺功能、炎症因子及应激反应的影响[J].海南医学院学报,2016,22(16):1914-1917.
[24]周瑜,黄涛,傅勇,等.全胸腔镜下食管癌根治术对炎症因子及患者生存质量的影响研究[J].检验医学与临床,2014(18):2561-2562.
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