胸腔镜与开胸手术方式对食管癌患者围术期单肺通气时Qs/Qt炎性因子淋巴结清扫的影响

doi:10.3969/j.issn.1006-6233.2020.07.005

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摘要 目的:探究胸腔镜术、开胸手术对食管癌患者围术期单肺通气时Qs/Qt、炎性因子及淋巴结清扫的影响。方法:前瞻性的选取2017年7月至2019年10月在我院行食管癌术的58例患者作为研究对象,按患者自身意愿分为传统开胸术(对照组,26例)、胸腔镜术(观察组,32例);收集临床指标,记录单肺通气不同时点的Qs/Qt,分析炎性因子水平,并观察预后情况。结果:两组患者术后各时点Qs/Qt水平均显著升高,差异有统计学意义(P<0.05);同时点比较,观察组T1、T2、T3的Qs/Qt水平分别为(37.28±1.76)%、(44.91±2.57)%、(38.82±3.67)%,显著高于对照组的(30.31±1.80)%、(37.60±3.01)%、(33.28±3.15)%,差异有统计学意义(P<0.05)。临床指标比较,观察组出血量、住院时间分别为(186.66±71.25)mL、(12.85±2.06)d,显著低于对照组的(352.93±80.99)mL、(14.46±2.25)d,差异有统计学意义(P<0.05)。观察组术后2d的肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)水平及术前与术后2d差值分别为(37.59±11.31)pg/mL、(132.66±34.9)pg/mL、(13.98±5.22)pg/mL、(91.27±28.96)pg/mL,均显著低于对照组的(56.83±16.64)pg/mL、(189.63±56.86)pg/mL、(32.60±6.57)pg/mL、(161.28±34.65)pg/mL,差异有统计学意义(P<0.05)。此外,两组患者在手术时间、淋巴结清除数、并发症发生率及生存时间上比较,差异无统计学意义(P>0.05)。结论:胸腔镜术、开腹术对食管癌均有淋巴结清除、并发症及生存时间上效果相当,但胸腔镜术在缩短住院时间、减弱炎性反应上更具优势,而开胸术单肺通气的Qs/Qt水平较低。

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	张彪
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关键词 ：食管癌, 胸腔镜术, 开胸术, 单肺通气

Abstract：Objective: To investigate the effects of thoracoscopy and thoracotomy on Qs/Qt, inflammatory factors and lymph node dissection during perioperative one-lung ventilation in patients with esophageal cancer. Methods: 58 cases of esophageal carcinoma between July 2017 and October 2019 in our hospital were selected prospectively as the research object and divided on the patients’ own willingness into traditional thoracotomy group (the control group, 26 cases) and thoracoscope group (observation group,32 cases). Clinical indicators were collected, Qs/Qt at different time points of single lung ventilation was recorded, inflammatory factor levels were analyzed, and prognosis was observed. Results: Postoperative Qs/Qt levels of 2 groups of patients were significantly elevated at each point of time, and the difference was statistically significant (P<0.05); The same point of time comparison showed that in the observation group Qs/Qt levels of T1, T2 and T3 were (37.28±1.76) %, (44.91±2.57) %, (38.82±3.67) %, significantly higher than those of the control group (30.31±1.80) %, (37.60±3.01) %, (33.28±3.15) %, and the difference was statistically significant (P<0.05). The comparison of clinical indexes showed that blood loss and hospital stay of the observation group were (186.66±71.25)mL, (12.85±2.06)d, significantly lower than the control group (352.93±80.99) mL, (14.46±2.25) d, and the difference was statistically significant (P<0.05). Postoperative comparison showed that 2 d TNF-α, IL-8 levels in preoperative period and postoperative 2 d period were (37.59±11.31)pg/mL, (132.66±34.9) pg/mL, (13.98 ± 5.22)pg/mL, (91.27±28.96) pg/mL, significantly lower than control group (56.83±16.64) pg/mL, (189.63±56.86)pg/mL, (32.60±6.57) pg/mL, (161.28±34.65) pg/mL, and the difference was statistically significant (P<0.05). In addition, the operation time, the number of lymph nodes clearance, the incidence of complications and survival time had no statistically significant difference (P>0.05). Conclusion: Both thoracoscopy and laparotomy had similar effects on lymph node clearance, complications and survival time of esophageal cancer, but thoracoscopy had more advantages in shortening hospital stay and reducing inflammatory response, while the Qs/Qt level of single-lung ventilation during thoracotomy was lower.

Key words： Esophageal cancer Thoracoscopy Thoracotomy One-lung ventilation

基金资助:安徽省卫生计生委科研计划项目,(编号:2018AHQK063)

引用本文:

张彪, 李俊青, 顾江魁. 胸腔镜与开胸手术方式对食管癌患者围术期单肺通气时Qs/Qt炎性因子淋巴结清扫的影响[J]. 河北医学, 2020, 26(7): 1075-1078.
ZHANG Biao, LI Junqing, GU Jiangkui. The Effects of Thoracoscopy and Thoracotomy on Qs/Qt Inflammatory Factors and Lymph Node Clearance During Perioperative One-lung Ventilation in Patients with Esophageal Cancer. HeBei Med, 2020, 26(7): 1075-1078.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.07.005 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I7/1075

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