微创小切口手术对早期胸中下段食管癌患者的治疗效果及对其疼痛的影响
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摘要
目的探究微创小切口手术对早期胸中下段食管癌患者的治疗效果及对其疼痛的影响。方法选取2016年3月—2017年3月在我院接受治疗的早期胸中下段食管癌患者160例,随机分为常规手术组和微创小切口手术组各80例,常规手术组患者使用常规手术治疗,微创小切口手术组患者使用微创小切口手术治疗。对肺活量(Vital capacity,VC)、一秒用力呼气容积(Forced expiratory volume 1,FEV1)检测、视觉模拟评分法(Visual analogue scale,VAS)、住院时间、手术时间及术中出血量进行统计,酶联免疫法检测应激激素如生长激素(Growth hormone,GH)、皮质醇(Cortisol,Cor)、白介素-8(Inter-leukin-8,IL-8)水平,并对两组患者不良反应发生情况进行统计。结果微创小切口手术组VC、FEV1水平显著高于常规手术组,出血量、手术时间、及住院时间短于常规手术组,GH、Cor水平、VAS评分、不良反应发生率低于常规手术组,IL-8高于常规手术组,差异均具有统计学意义(P <0. 05)。结论微创小切口手术治疗早期胸中下段食管癌效果显著,能够缓解患者疼痛,减少不良反应。
Objective The aim of this study was to explore the effect of minimally invasive small incision surgery on early thoracic esophageal cancer patients and its impact on pain. Methods A total of 160 patients with early thoracic esophageal cancer who were treated in our hospital from March 2016 to March 2017 were randomly divided into the conventional surgery group and the minimally invasive small incision surgery group. Patients in the conventional surgery group were treated with routine operation,and patients in the minimally invasive small incision surgery group were treated with minimally invasive small incision surgery. Vital capacity( VC),forced expiratory volume 1( FEV1),visual analogue scale( VAS),hospitalization time,operation time and intraoperative bleeding volume were counted. Growth hormone( GH) was detected by ELISA. The levels of cortisol( Cor) and interleukin-8( IL-8) were measured by immunoassay and adverse reactions. Results The levels of VC and FEV1 in the minimally invasive small incision group were significantly higher than those in the conventional surgery group. The bleeding volume,operation time and hospitalization time were shorter than those in the conventional surgery group. The levels of GH and Cor,VAS score and incidence of adverse reaction rate were lower than those in the conventional surgery group,and the level of IL-8 was also higher in than that in the conventional surgery group. The difference was statistically significant( P < 0. 05). Conclusion Minimally invasive small incision surgery is effective on the treatment of early thoracic esophageal cancer,relieving pain and reducing adverse reactions.
Objective The aim of this study was to explore the effect of minimally invasive small incision surgery on early thoracic esophageal cancer patients and its impact on pain. Methods A total of 160 patients with early thoracic esophageal cancer who were treated in our hospital from March 2016 to March 2017 were randomly divided into the conventional surgery group and the minimally invasive small incision surgery group. Patients in the conventional surgery group were treated with routine operation,and patients in the minimally invasive small incision surgery group were treated with minimally invasive small incision surgery. Vital capacity( VC),forced expiratory volume 1( FEV1),visual analogue scale( VAS),hospitalization time,operation time and intraoperative bleeding volume were counted. Growth hormone( GH) was detected by ELISA. The levels of cortisol( Cor) and interleukin-8( IL-8) were measured by immunoassay and adverse reactions. Results The levels of VC and FEV1 in the minimally invasive small incision group were significantly higher than those in the conventional surgery group. The bleeding volume,operation time and hospitalization time were shorter than those in the conventional surgery group. The levels of GH and Cor,VAS score and incidence of adverse reaction rate were lower than those in the conventional surgery group,and the level of IL-8 was also higher in than that in the conventional surgery group. The difference was statistically significant( P < 0. 05). Conclusion Minimally invasive small incision surgery is effective on the treatment of early thoracic esophageal cancer,relieving pain and reducing adverse reactions.
引文
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2 Bharat A,Crabtree T. Management of advanced-stage operable esophageal cancer[J]. Surg Clin North Am,2012,92(5):1179-1197.
3 Mudge LA,Watson DI,Smithers BM,et al. Australian Immunonutrition Study Group. Multicentre factorial randomized clinical trial of perioperative immunonutrition versus standard nutrition for patients undergoing surgical resection of oe- sophageal cancer[J]. Br J Surg,2018,105(10):1262-1272.
4 刘梦虓,熊章荣,牟林,等.硬膜外复合皮下多模式镇痛用于开胸食管癌手术患者的临床研究[J].重庆医学,2015,44(15):2048-2050.
5 Fang Q,Han YT,Ren GG,et. al. Effect of minimally invasive Ivor-Lewis esophagectomy on acute phase responses in patients with esophageal carcinoma[J]. Zhonghua Zhong Liu Za Zhi,2010,32(11):868-871.
6 薛肖雷.左右胸不同路径手术对胸中段食管癌患者的治疗效果对比研究[J].中国医药导刊,2016,18(3):219-220.
7 He H,Wu Q,Wang Z,et al. Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer:a propensity score matched analysis[J]. J Cardiothorac Surg,2018,13(1):52.
8 Kato H,Nakajima M. Treatments for esophageal cancer:a review[J]. Gen Thorac Cardiovasc Surg,2013,61(6):330-335.
9 Ramos D,Priego P,Coll M,et al. Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma[J]. Rev Esp Enferm Dig,2016,108(1):8-14.
10 李镇南.探讨不同术式治疗早期胸段食道癌的临床疗效[J].中国卫生标准管理,2015,6(32):69-70.
11 Lee DH,Kim HR,Kim SR,et al. Comparison of clinical outcomes after conservative and surgical treatment of isolated anastomotic leaks after esophagectomy for esophageal cancer[J]. Dis Esophagus,2013,26(6):609-615.
12黎亮,汤昔康.术前放疗联合小切口胸段食管癌根治术治疗胸段食管癌疗效及其对患者肺功能的影响[J].临床和实验医学杂志,2015,14(12):1020-1022.
13 姜国栋.探究不同术式治疗早期胸段食管癌的临床疗效和对患者预后的影响[J].中国继续医学教育,2016,8(31):123-124.
14 张成,张黎明.小切口食管癌根治术与传统切口食管癌根治术治疗胸段食管癌临床疗效及并发症对比研究[J].中国实用医药,2015,10(35):47-48.
15 向绍华.左胸微创小切口治疗胸中下段食管癌的临床效果分析[J].中外医疗,2016,35(16):118-119.
16 宋和平.高龄胸中下段食管癌经左胸微创小切口治疗的临床效果观察[J].中国现代药物应用,2015,9(24):46-47.
17 Maas KW,Biere SS,van Hoogstraten IM,et al. Immunological changes after minimally invasive or conventional esophageal resection for cancer:a randomized trial[J].World J Surg,2014,38(1):131-137.
18 胡志向. SLIPA喉罩在老年腹腔镜手术中的通气效果及对NE、E、Cor水平的影响[J].检验医学与临床,2017,14(21):3145-3147.
19 李志龙,王一心,臧建洲,等.不同食管癌根治术对患者术后肺功能及炎性因子水平的影响[J].检验医学与临床,2016,13(6):746-748.
20 Huang HT,Wang F,Shen L,et al. Comparison of thoracolaparoscopic esophagectomy with cervical anastomosis with McKeown esophagectomy for middle esophageal cancer[J]. World J Surg Oncol,2015,13:310.
2 Bharat A,Crabtree T. Management of advanced-stage operable esophageal cancer[J]. Surg Clin North Am,2012,92(5):1179-1197.
3 Mudge LA,Watson DI,Smithers BM,et al. Australian Immunonutrition Study Group. Multicentre factorial randomized clinical trial of perioperative immunonutrition versus standard nutrition for patients undergoing surgical resection of oe- sophageal cancer[J]. Br J Surg,2018,105(10):1262-1272.
4 刘梦虓,熊章荣,牟林,等.硬膜外复合皮下多模式镇痛用于开胸食管癌手术患者的临床研究[J].重庆医学,2015,44(15):2048-2050.
5 Fang Q,Han YT,Ren GG,et. al. Effect of minimally invasive Ivor-Lewis esophagectomy on acute phase responses in patients with esophageal carcinoma[J]. Zhonghua Zhong Liu Za Zhi,2010,32(11):868-871.
6 薛肖雷.左右胸不同路径手术对胸中段食管癌患者的治疗效果对比研究[J].中国医药导刊,2016,18(3):219-220.
7 He H,Wu Q,Wang Z,et al. Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer:a propensity score matched analysis[J]. J Cardiothorac Surg,2018,13(1):52.
8 Kato H,Nakajima M. Treatments for esophageal cancer:a review[J]. Gen Thorac Cardiovasc Surg,2013,61(6):330-335.
9 Ramos D,Priego P,Coll M,et al. Comparative study between open and minimally invasive approach in the surgical management of esophageal leiomyoma[J]. Rev Esp Enferm Dig,2016,108(1):8-14.
10 李镇南.探讨不同术式治疗早期胸段食道癌的临床疗效[J].中国卫生标准管理,2015,6(32):69-70.
11 Lee DH,Kim HR,Kim SR,et al. Comparison of clinical outcomes after conservative and surgical treatment of isolated anastomotic leaks after esophagectomy for esophageal cancer[J]. Dis Esophagus,2013,26(6):609-615.
12黎亮,汤昔康.术前放疗联合小切口胸段食管癌根治术治疗胸段食管癌疗效及其对患者肺功能的影响[J].临床和实验医学杂志,2015,14(12):1020-1022.
13 姜国栋.探究不同术式治疗早期胸段食管癌的临床疗效和对患者预后的影响[J].中国继续医学教育,2016,8(31):123-124.
14 张成,张黎明.小切口食管癌根治术与传统切口食管癌根治术治疗胸段食管癌临床疗效及并发症对比研究[J].中国实用医药,2015,10(35):47-48.
15 向绍华.左胸微创小切口治疗胸中下段食管癌的临床效果分析[J].中外医疗,2016,35(16):118-119.
16 宋和平.高龄胸中下段食管癌经左胸微创小切口治疗的临床效果观察[J].中国现代药物应用,2015,9(24):46-47.
17 Maas KW,Biere SS,van Hoogstraten IM,et al. Immunological changes after minimally invasive or conventional esophageal resection for cancer:a randomized trial[J].World J Surg,2014,38(1):131-137.
18 胡志向. SLIPA喉罩在老年腹腔镜手术中的通气效果及对NE、E、Cor水平的影响[J].检验医学与临床,2017,14(21):3145-3147.
19 李志龙,王一心,臧建洲,等.不同食管癌根治术对患者术后肺功能及炎性因子水平的影响[J].检验医学与临床,2016,13(6):746-748.
20 Huang HT,Wang F,Shen L,et al. Comparison of thoracolaparoscopic esophagectomy with cervical anastomosis with McKeown esophagectomy for middle esophageal cancer[J]. World J Surg Oncol,2015,13:310.