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中国临床研究:2019,32(12):1678-1681
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双镜联合微创手术对胸段食管癌患者肺功能、红细胞免疫、细胞免疫功能的影响
(青海省第五人民医院胸外科,青海 西宁 810007)
Effect of thoracoscopy combined with laparoscopy on lung function,erythrocyte immunity and cellular immunity in patients with thoracic esophageal cancer
(Department of Thoracic Surgery,The Fifth People′s Hospital of Qinghai Province,Xining,Qinghai 810007,China)
摘要
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投稿时间:2019-05-15   网络发布日期:2019-12-23
中文摘要: 目的 探讨胸腔镜联合腹腔镜对胸段食管癌根治术患者肺功能、红细胞免疫、细胞免疫的影响。方法 选取2017年2月至2019年3月于确诊为胸段食管癌并住院治疗的95例患者作为研究对象,根据患者的需求及自身条件分为观察组(50例)和对照组(45例),对照组采用传统食管癌手术切除,观察组在胸腔镜、腹腔镜辅助条件下进行手术。比较手术前后两组患者的肺功能、红细胞免疫、细胞免疫功能以及血清创伤指标。结果 手术后所有患者的肺功能指标均有明显的改善(P<0.05)。手术后,两组患者肺活量(VC)、第一秒用力呼气容积(FEV1)、每分钟最大通气量(MVV)与手术前相比均降低(P<0.05);对照组VC、FEV1、MVV低于观察组(P<0.05)。手术结束时观察组红细胞黏附肿瘤细胞花环率(RBC-TRR)和红细胞C3b受体花环率(RBC-C3bRR)明显降低(P<0.05),红细胞免疫复合物花环率(RBC-ICR)明显增高(P<0.05),术后1 d TRR、RBC-C3bRR回升,RBC-ICR回降,至术后3 d均恢复至术前水平;术后观察组的RBC-C3bRR、RBC-TRR显著高于对照组,其RBC-ICR明显低于对照组(P<0.01)。手术结束时观察组CD3+、CD4+、CD4+/CD8+ 较治疗前降低(P<0.05),术后1 d逐渐升高,术后3 d恢复至术前水平;对照组在术后各时间点与观察组差异均有统计学意义(P<0.05)。手术结束时观察组前列腺素E2(PGE2)、白细胞介素(IL)-6、皮质醇(Cor)含量较治疗前升高(P<0.05),术后1 d逐渐降低,术后3 d恢复至术前水平;对照组在术后各时间点与观察组差异均有统计学意义(P<0.01)。结论 在需行胸段食管癌根治术患者中,应用胸腔镜联合腹腔镜对其肺功能及细胞免疫的影响较小,且可明显减轻手术对患者的损伤。
Abstract:Objective To investigate the effect of thoracoscopy combined with laparoscopy on thoracic esophageal cancer and its influence on lung function,erythrocyte immunity and cellular immunity. Methods A total of 95 patients who were diagnosed as thoracic esophageal cancer in the Fifth People′s Hospital of Qinghai Province from February 2017 to March 2019 were selected as study objects.According to the needs of the patients and their own conditions,the patients were divided into the observation group (n=50) and the control group (n=45).The control group was operated by traditional esophageal cancer resection,and the observation group was operated under the assistance of thoracoscopy and laparoscopy.The lung function,erythrocyte immunity,cellular immunity and serum trauma indexes of the two groups were compared before and after treatment. Results The pulmonary function indexes of all patients were improved significantly after treatment (all P<0.05).After treatment,vital capacity (VC),forced expiratory volume in first second (FEV1) and maximal voluntary ventilation (MVV) decreased in both groups,while VC,FEV1 and MVV of the control group were significantly lower than those of the observation group (all P<0.01).At the end of the operation,RBC-TRR and RBC-C3bRR in the observation group were significantly decreased (P<0.05),and RBC-ICR increased (P<0.05);RBC-TRR and RBC-C3bRR re-increased and RBC-ICR re-decreased 1 day after operation,and all three indexes recovered to preoperative level 3 days after operation.The RBC-C3bRR and RBC-TRR of the observation group were significantly higher than those of the control group,and RBC-ICR of the observation group was significantly lower than that of the control group (P<0.01).At the end of the operation,CD3+,CD4+ and CD4+/CD8+ in the observation group were lower than those before treatment (P<0.05),and gradually increased on the first day after operation and recovered to the preoperative level on the third day after operation.There was significant difference between two group at each time point after operation (all P<0.05).At the end of operation,the levels of prostaglandin E2 (PGE2),interleukin (IL)-6 and cortisol (Cor) in the observation group were significantly higher than those before the treatment (P<0.05).There was significant difference between two group at each time point after operation (all P<0.01). ConclusionThoracoscopy combined with laparoscopy may have little effect on lung function and cellular immunity in patients who need to receive radical operation of thoracic esophageal cancer,and can significantly reduce perioperative injury.
文章编号:     中图分类号:R 735.1    文献标志码:B
基金项目:青海省卫计委医药卫生科技项目(2018-wjzdx-46)
引用文本:
董锦忠.双镜联合微创手术对胸段食管癌患者肺功能、红细胞免疫、细胞免疫功能的影响[J].中国临床研究,2019,32(12):1678-1681.

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