不同路径下腔镜微创贲门癌根治术的疗效及对术后残余胃肠功能营养状况的影响

doi:10.3969/j.issn.1006-6233.2024.06.019

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Abstract Objective: To investigate the efficacy of laparoscopic minimally invasive radical surgery for esophageal cancer via different approaches and its influence on postoperative residual gastrointestinal function and nutritional status.Methods: A total of 126 patients with esophageal cancer admitted to our hospital from May 2020 to May 2023 were selected and randomly divided into two groups: the transabdominal group and the thoracoabdominal group, with 63 cases in each group. The transabdominal group underwent laparoscopic minimally invasive radical surgery, while the thoracoabdominal group underwent thoracoabdominal combined laparoscopic minimally invasive radical surgery. The efficacy, perioperative conditions, trauma indicators [pre- and postoperative levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8)], gastrointestinal function indicators [postoperative gastric tube removal time, anal exhaust time, eating time, pre- and postoperative levels of vasoactive intestinal peptide (VIP), somatostatin (SS), motilin (MTL)], nutritional status [pre- and postoperative serum albumin (ALB), prognostic nutritional index (PNI), subjective global assessment (SGA) score], and postoperative complications were compared between the two groups.Results: The comparison of positive margin rate, surgical cure rate between the two groups showed no statistical significance (P>0.05); the thoracoabdominal group had shorter operative time (131.52±18.77) min, postoperative anal exhaust time (2.52±0.60) d, postoperative nasogastric tube removal time (2.88±0.47) d, postoperative oral intake time (4.38±0.85) d, postoperative ambulation time (5.82±1.16) d, and hospital stay (10.72±2.01) d, all shorter than those of the abdominal group [(155.94±21.67) min, (3.40±0.66) d, (3.34±0.53) d, (5.62±0.92) d, (7.10±1.24) d, (12.39±2.33) d, respectively], intraoperative blood loss, and postoperative drainage volume were (112.46±14.21) mL and (160.89±22.37) mL, respectively, both lower than those of the abdominal group [(124.31±16.08) mL, (186.27±20.15) mL, respectively], the number of lymph nodes dissected was (15.27±1.76), higher than that of the abdominal group (13.15±1.63) (t=6.761, 7.831, 5.154, 7.858, 5.983, 4.308, 4.383, 6.691, 7.015, all P<0.001); on postoperative days 1 and 3, serum CRP levels of the thoracoabdominal group were (72.36±16.20) mg/L and (35.28±10.08) mg/L, respectively, lower than those of the abdominal group [(96.58±14.77) mg/L and (51.17±11.62) mg/L, respectively], IL-6 levels were (212.34±33.16) ng/L and (142.32±23.57) ng/L, respectively, lower than those of the abdominal group [(254.39±37.49) ng/L and (180.67±27.13) ng/L, respectively], IL-8 levels were (0.28±0.09) μg/L and (0.14±0.04) μg/L, respectively, lower than those of the abdominal group [(0.42±0.11) μg/L and (0.25±0.07) μg/L, respectively], VIP levels were (28.76±4.05) pg/mL and (34.69±4.28) pg/mL, respectively, higher than those of the abdominal group [(25.14±3.63) pg/mL and (30.52±3.91) pg/mL, respectively], SS levels were (18.23±3.10) pg/mL and (20.21±2.36) pg/mL, respectively, higher than those of the abdominal group [(16.17±2.86) pg/mL and (18.08±2.44) pg/mL, respectively], MTL levels were (242.16±21.18) pg/mL and (257.90±23.25) pg/mL, respectively, higher than those of the abdominal group [(227.43±20.64) pg/mL and (238.41±21.76) pg/mL, respectively] (t=8.769, 8.199, 6.668, 8.470, 7.818, 10.829, 5.283, 5.709, 3.877, 4.980, 3.953, 4.858, all P<0.001); 1 month postoperatively, serum ALB and the difference values of the thoracoabdominal group were (75.61±8.03) g/L and (11.95±6.51) g/L, respectively, higher than those of the abdominal group [(70.58±5.95) g/L and (70.58±5.95) g/L, respectively], PNI and the difference values were (62.48±6.17) and (14.22±5.13) g, respectively, higher than those of the abdominal group [(57.13±5.82) and (8.60±5.22), respectively], SGA scores and the difference values were (9.08±1.42) points and (5.49±1.58) points, respectively, higher than those of the abdominal group [(11.15±1.76) points and (3.06±1.49) points, respectively] (t=3.944, 4.8470, 5.007, 6.095, 7.265, 8.881, all P<0.001); the incidence of complications in the thoracoabdominal group was 6.35%, lower than that in the abdominal group of 19.05% (χ²=4.582, P=0.032). Conclusion: Thoracoabdominal combined laparoscopic minimally invasive radical surgery for esophageal cancer is effective, can optimize the surgical pathway, reduce tissue trauma, help restore gastrointestinal function, improve patient nutritional status, reduce the incidence of complications, and accelerate postoperative recovery.

Key words： Esophageal cancer Abdominal cavity pathway Thoracoabdominal combined pathway Radical resection of esophageal cancer Gastrointestinal function

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2024.06.019 OR http://www.hbyxzzs.cn/EN/Y2024/V30/I6/973

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