摘要
目的探究全胸腔镜手术治疗早期食管癌的中远期疗效及对患者手术后应激、免疫功能的影响。方法前瞻性选取2017年1月至2019年10月江苏省肿瘤医院胸收治的102例早期食管癌患者为本次研究对象,随机数字表法分为观察组(n=51)及对照组(n=51)。对照组开展传统手术治疗,观察组开展全胸腔镜手术治疗。比较两组的应激反应[C反应蛋白(CRP)、皮质醇、肾上腺素(E)]、免疫功能、炎症反应[白细胞介素(IL)-6、IL-8、IL-10、肿瘤坏死因子α(TNF-α)]、并发症发生率及中远期疗效。结果手术后,观察组CRP、皮质醇、E水平分别为(29.65±3.64)mg/L、(182.65±30.10)μg/L、(56.62±4.25)ng/mL,均低于对照组[(45.56±4.25)mg/L、(196.32±31.25)μg/L、(72.26±4.21)ng/mL],差异均有统计学意义(P<0.05)。手术后,观察组CD4^(+)、CD4^(+)/CD8^(+)水平分别为(32.25±2.11)%、1.10±0.15,均高于对照组[(28.98±2.14)%、0.86±0.11],CD8^(+)水平为(29.22±2.52)%,低于对照组[(33.62±2.58)%],差异均有统计学意义(P<0.05)。手术后,观察组的IL-6、IL-8、IL-10、TNF-α水平分别为(2.72±0.42)pg/mL、(2.25±0.32)pg/mL、(0.68±0.10)pg/mL、(1.30±0.21)ng/mL,均低于对照组[(2.96±0.45)pg/mL、(2.69±0.35)pg/mL、(0.87±0.11)pg/mL、(1.71±0.23)ng/mL],差异均有统计学意义(P<0.05)。观察组的并发症发生率为5.88%,对照组为17.65%,组间比较差异无统计学意义(P>0.05)。手术后18个月,观察组复发率、转移率、病死率分别为5.88%、3.92%、0,对照组分别为3.92%、3.92%、0,手术后36个月,观察组复发率、转移率、病死率分别为13.73%、7.84%、3.92%,对照组分别为7.84%、7.84%、3.92%,组间比较差异无统计学意义(P>0.05)。结论全胸腔镜手术治疗早期食管癌,较传统手术而言,可有效缓解机体应激反应,解除免疫抑制的基础上,稳定免疫功能,缓解炎症反应,且安全性较高,中远期疗效与传统手术无较大差异。
Objective To explore the medium and long term efficacy of total thoracoscopic surgery in the treatment of early esophageal cancer and its influence on postoperative stress and immune function.Methods A total of 102 patients with early esophageal cancer admitted to Jiangsu Cancer Hospital from January 2017 to October 2019 were selected as subjects of this study.They were divided into observation group(n=51)and control group(n=51)according to the random number table.The control group underwent traditional surgery,and the observation group underwent thoracoscopic surgery.The stress response[C-reactive protein(CRP),cortisol,adrenaline(E)],immune function,inflammatory response[interleukin(IL)-6,IL-8,IL-10,tumor necrosis factorα(TNF-α)],incidence of complications,and mid-term and long-term efficacy were compared between the two groups.Results After operation,the levels of CRP,cortisol and E in the observation group were(29.65±3.64)mg/L,(182.65±30.10)μg/L,(56.62±4.25)ng/mL,respectively,which were lower than those in the control group[(45.56±4.25)mg/L,(196.32±31.25)μg/L,(72.26±4.21)ng/mL],and the differences were statistically significant(P<0.05).After operation,the levels of CD4^(+),CD4^(+)/CD8^(+)in the observation group were(32.25±2.11)%,1.10±0.15,respectively,which were higher than those in the control group[(28.98±2.14)%,0.86±0.11],and the level of CD8^(+)was(29.22±2.52)%,which was lower than that in the control group[(33.62±2.58)%],and the difference was statistically significant(P<0.05).After operation,the levels of IL-6,IL-8,IL-10,TNF-α in the observation group were(2.72±0.42)pg/mL,(2.25±0.32)pg/mL,(0.68±0.10)pg/mL,(1.30±0.21)ng/mL,respectively,which were significantly lower than those in the control group[(2.96±0.45)pg/mL,(2.69±0.35)pg/mL,(0.87±0.11)pg/mL,(1.71±0.23)ng/mL],and the differences were statistically significant(P<0.05).The complication rate in the observation group was 5.88%,in the control group was 17.65%,there was no statistically significant difference between two groups(P>0.05).At 18 months after the surgery,the recurrence rate,metastasis rate,and mortality rate in the observation group were 5.88%,3.92%,and 0,respectively,The control group was 3.92%,3.92%,0;at 36 months after surgery,the recurrence rate,metastasis rate,and mortality rate of the observation group were 13.73%,7.84%,and 3.92%,respectively,The control group was 7.84%,7.84%,and 3.92%,there were no statistically significant differences between two groups(P>0.05).Conclusion Compared with traditional surgery,thoracoscopic surgery for the treatment of early esophageal cancer can effectively relieve the stress response of the body,relieve the immune suppression,stabilize the immune function,relieve the inflammatory response,and have higher safety.There is no significant difference between the medium and long term efficacy and the traditional surgery.
作者
王颖
夏红香
倪婧鑫
刘梦媛
周静
刘文卉
WANG Ying;XIA Hong-xiang;NI Jing-xin(Department of Thoracic Surgery,Jiangsu Cancer Hospital,Nanjing Jiangsu 210009,China)
出处
《临床和实验医学杂志》
2023年第9期949-953,共5页
Journal of Clinical and Experimental Medicine
基金
国家自然科学基金(编号:81802907)。
关键词
全胸腔镜手术治疗
早期食管癌
中远期疗效
应激反应
免疫功能
Total thoracoscopic surgery
Early esophageal carcinoma
Medium and long term efficacy
Stress response
Immune function
