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

黄修明 陈献珊 陈锋夏

[摘要] 目的 探討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。

[关键词] 全胸腔镜食管癌根治术;开胸食管癌根治术;炎性反应;应激反应;影响

[中图分类号] R735.1          [文献标识码] A          [文章编号] 1673-7210（2019）02（b）-0104-04

[Abstract] 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.

[Key words] Total thoracic esophageal cancer radical surgery; Open thoracic esophageal cancer radical surgery; Inflammation reaction; Stress response; Effect

食管癌是常见的消化道恶性肿瘤，多发于中老年群体，主要临床症状为吞咽困难、背痛、腹腔积液以及胸痛[1]。全世界每年约有30万人死于食管癌，我国是食管癌高发地区之一，每年平均病死约15万人[2]。目前该病的治疗方法以手术根治为主，开胸食管癌根治术是胸外科中常见的手术方式;然而，该术式术后创伤大，并发症多，影响患者预后[3]。随着……