胸腔镜切除术与传统式手术对食管癌术后肺部功能和炎症细胞因子的影响

摘要

Objective To study the effect of video-assisted thoracic ( VAST) surgery and traditional surgery on the lung function and inflammatory cytokines of esophageal carcinoma .Methods 58 patients with esophageal carcinoma were divided into 2 groups,25 cases with video-assisted thoracic surgery treatment were as VAST group and 33 cases were treated with traditional surgery as traditional group .The related operation situation and incidence of postoperative complications of the 2 groups were com-pared.Additionally,preoperative and postoperative lung function (including VC,FVC,FEV1,and MVV) and the levels of inflam-matory cytokines ( including IL-6、IL-8、IL-10、TNF-α) of both groups were compared .Results Difference in number of cleaning lymph nodes between the 2 groups were not obvious (P>0.05),while operative time,operative bleeding,and hospitalstays of VAST group were significantly lower than those of traditional group (P<0.05).Although the difference was not significant (P>0.05),the incidence rate of anastomotic fistula ,anastomotic bleeding,and chest infection in VAST group were lower than those of traditional group .In addition , after the surgery , indicators of postoperative lung function in both groups showed a decrease , and those in VAST group were significantly higher (P<0.05).Meanwhile,IL-8、IL-10,and TNF-αof VAST group were much lower than those of traditional group (P<0.05).Conclusion VAST surgery has a good ability in maintaining the level of lung func-tion and inhibiting the changes of inflammatory cytokines when compared with traditional surgery .%目的 对比分析胸腔镜切除术与传统式手术对食管癌术后肺部功能、炎症细胞因子的影响.方法 选择经术前胃镜病理活检确诊的食管癌患者58例,25例行胸腔镜食管癌切除术,作为胸腔镜组,33例行传统常规开胸食管癌切除术,作为传统组.比较分析两组患者的手术情况、并发症发生情况.同时,对两组患者的术前及术后1个月肺功能(包括VC、FVC、FEV1、MVV),术前1~2 d及术后1周炎症因子(IL-6、IL-8、IL-10、TNF-α)进行测定,观察两组患者的肺功能以及炎症因子的变化.结果 两组的淋巴结清扫数目比较差异无统计学意义(P>0.05);而胸腔镜组的手术时间、出血量及住院时间显著优于传统组(P<0.05);胸腔镜组患者术后的吻合口瘘、吻合口出血、胸腔感染发生率均低于传统组,但无统计学意义(P>0.05);术后1个月,两组患者的肺部功能各项指标水平较术前均明显降低,而胸腔镜组患者的各项指标水平均显著高于传统组患者(P<0.05);术后1周,两组患者的各项指标较术前均有所升高,且胸腔镜组患者的IL-8、IL-10以及TNF-α水平均显著低于传统组患者(P<0.05).结论 相较于传统式手术,胸腔镜食管癌切除术能够一定程度维持患者的正常肺部功能,同时可有效抑制炎症细胞因子的释放.