胸腹腔镜与传统开胸手术对食管癌患者术后炎症因子的影响

目的 对比研究胸腹腔镜手术(minimally invasive esphagectomy,MIE)与传统开胸手术(open esophagectomy,OE)食管癌患者术后炎症因子水平的变化,探讨两种手术方法引起炎性反应的差异.方法 选取2015年1 1月至2016年3月重庆医科大学附属第一医院胸心外科符合研究标准的食管癌患者共28例(MIE组及OE组各14例),采集患者术前和术后6、12、24、48 h血液样本.采用ELISA测定血清细胞因子内皮素(endothelin,ET)、白细胞介素-8(interleukin-8,IL-8)、白细胞介素-10(IL-I0)及肿瘤坏死因子α(tumour necrosis factorα,TNF-α)水平.结果 OE组中位年龄为67.5岁,MIE组中位年龄为61岁,两组患者一般资料及手术时间差异无统计学意义(P＞0.05).与OE组比较,MIE组术中出血量、术后人ICU时间、术后留院时间及肺部感染例数差异均有统计学意义(P＜0.05).术后第6、12、24小时血清IL-8水平,术后第6、12小时血清TNF-d水平,术后各时间点血清IL-10水平差异均有统计学意义(P＜0.05).结论 与传统开胸手术比较,胸腹腔镜手术治疗食管癌引起的炎症反应程度相对较轻,更有利于患者术后恢复.

Effect of minimally invasive esphagectomy vs open esophagectomy on post-operative cytokines in esophageal cancer patients

Objective To observe the dynamic changes of post-operative cytokine levels in esophageal cancer patients after minimally invasive esophagectomy (MIE) and open esophagectomy (OE),and investigate the discrepancy of inflammatory response between the 2 approaches.Methods A total of 28 esophageal cancer patients admitted in the First Affiliated Hospital of Chongqing Medical University from November 2015 to March 2016 were prospectively recruited in this study.They were divided into 2 groups (n =14 for each group),undergoing MIE (MIE group) and OE (OE group) respectively.The blood samples were collected before and at 6,12,24 and 48 h after operation.Double-antibody sandwich ELISA were applied to detect serum levels of endothelin (ET),interleukin-8 (IL-8),IL-10 and tumor necrosis factor α (TNF-α),respectively.Results The median age was 67.5 years in the OE group,and 61 years in the MIE group.There were no significant differences between the 2 groups in preoperative clinical data and operative times (P ＞ 0.05).The MIE group had less amount of median intraoperative blood loss,shorter median length of ICU stay,shorter median length of postoperative hospital stay and lower incidence of postoperative pulmonary complication (all P ＜ 0.05) when compared with the OE group.Significant differences were also seen in the serum levels of IL-8 at 6,12 and 24 h postoperatively,and TNF-α levels at 6 and 12 h postoperatively,as well as IL-10 at each postoperative time points between the 2 groups (P ＜ 0.05).Conclusion Compared with OE,MIE causes milder inflammatory responses,and is beneficial to postoperative recovery in esophageal cancer patients.