联合腔镜食管癌根治手术与常规手术相关炎性指标及痰量的比较

摘要

目的 探究电视胸腔镜联合腹腔镜食管癌根治性手术与常规手术术后炎性指标[(肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和高敏C反应蛋白(hs-CRP)]水平及痰量的差异,评估其对护理的影响.方法 将2011年12月至2012年12月收治的47例食管癌患者按手术方式不同分为联合腔镜组(25例)和常规手术组(22例)；检测并比较2组患者术前和术后血清TNF-α、IL-6及hs-CRP水平,同时测量2组患者术后的痰量.结果 术前血清炎性指标水平2组差异无统计学意义；术后联合腔镜组患者hs-CRP、TNF-α和IL-6水平明显低于常规手术组[分别为(1.96±1.08) mg/L比(2.64±1.12) mg/L,(22±8)ng/L比(28±6) ng/L,(23±12) ng/L比(61±14) ng/L,均P＜0.05]；且痰量明显少于常规手术组[(73±11)ml比(135±11)ml,P＜0.01].结论 胸腹腔镜联合行食管癌根治术术后炎症反应水平较常规手术降低,直接反映为术后痰量明显减少,对降低食管癌术后肺部护理强度有重要意义.%Objective To investigate the level of cytokines in laparscopy and video-assisted thoracoscopic surgery (VATS) in radical correction of esophageal carcinoma with the classical surgery.Methods Forty-seven patients with esophageal carcinoma between December 2011 and December 2012 were divided into combined laparoscope group(25 cases; thoracoscopic and laparscopic esophagectomy or laparoscope and video-assisted thoracoscopic surgery) and classical surgery group(22 cases).The levels of tumor necrosis factor alpha (TNF alpha),interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) of the two groups in preoperative and postoperative were measured and compared.The volume of sputum after the surgery was recorded.Results No significant difference was found in the postoperative value of hs-CRP,IL-6,TNF-α.Compared to the group of classical surgery,the level of hs-CRP,TNF-α,IL-6 and volume of sputum in the group of video-assisted thoracoscopic surgery were significantly lower after surgery [(1.96 ± 1.08) mg/L vs (2.64 ± 1.12) mg/L,(22 ± 8) ng/L vs (28 ± 6) ng/L,(23 ± 12) ng/L vs (61 ± 14) ng/L,(73 ± 11) ml vs (135 ± 11) ml,P ＜ 0.05 or P ＜ 0.01].Conclusion Combining thoracoscopic and laparscopic esophagectomy can reduce the postoperative inflammation levels and descend the pulmonary care intensity.