微创食管癌根治术对老年患者肺部感染与T淋巴细胞亚群及MMP－9的影响

目的探讨微创食管癌根治术对老年患者术后肺部感染、T淋巴细胞亚群及MMP－9的影响。 方法选取2015年1月到2017年12月98例老年食管癌患者作为研究对象，采用随机数字表法分为微创组(实施微创胸腹腔镜食管癌根治术)和传统组(实施传统食管癌根治术)。应用SPSS 19.0统计软件进行数据分析，术中术后指标、T细胞亚群、MMP－9水平指标以均值±标准差表示，组间比较采用独立t检验；术后肺部感染及死亡发生率指标，组间比较采用χ²检验。以P<0.05认为差异具有统计学意义。 结果微创组患者手术各项指标(手术切口平均总长度、平均手术时间、手术出血量、术后住院天数)均优于传统组患者(P<0.05)；微创组术后肺部感染率6.1%(3/49)明显低于传统组26.5%(13/49)，P<0.05；微创组患者术后第1天、3天T细胞亚群的各项指标的水平(CD3^＋、CD4^＋、CD4^＋/CD8^＋)均高于传统组(P<0.05)；微创组术后第1天、3天MMP－9水平均低于传统组，差异均有统计学意义(P<0.05)。 结论老年食管癌患者行微创胸腹腔镜食管癌根治术效果更好，可明显减轻手术创伤，改善外周血T淋巴细胞亚群及血清MMP－9水平，值得临床推广。

Influence of minimally invasive esophageal cancer radical resection on pulmonary infection,T lymphocyte subsets and MMP-9 in elderly patients

ObjectiveTo explore the influence of minimally invasive esophageal cancer radical resection on pulmonary infection, T lymphocyte subsets and MMP-9 in elderly patients. MethodsA total of 98 patients with elderly esophageal cancer from January 2015 to September 2017 were enrolled in the study. They were randomly divided into minimally invasive group and traditional group by using random number table method. The minimally invasive group was treated with minimally invasive esophageal cancer radical surgery, while the traditional group was treated with conventional esophagectomy. Surgical indicators, the incidence of postoperative lung infection, the level of T cell subsets and MMP-9 were observed and compared between the two groups. Statistical analysis were performed by using SPSS19.0 software. The surgical incision, operation time, blood loss, postoperative hospital stay, T-cell subsets, and MMP-9 levels were expressed as ( ±s), and were examined by using t test.The death rate was analyzed by Chi-square test. A P value <0.05 was considered as statistically significant difference. ResultsThe surgical indexes (average total length of the surgical incision, average operation time, amount of blood loss, postoperative hospital stay) in minimally invasive group were better than those in traditional group, with significant difference (P<0.05); The incidence of postoperative pulmonary infection in the minimally invasive group was 6.1%(3/49), significantly lower than 26.5%(13/49) in traditional group (P<0.05); 1 and 3 days after surgery, the levels of T-cell subgroups (CD3⁺ , CD4⁺ , CD4⁺ /CD8⁺ ) in minimally invasive group were higher than those of traditional group (P<0.05); The levels of MMP-9 in minimally invasive group was lower than in traditional group (P<0.05). ConclusionThe effect of minimally invasive thoracoscopic esophagectomy for esophageal cancer in elderly patients is better. It could significantly reduce the surgical trauma, and improve the peripheral blood T lymphocyte subsets and serum MMP-9 levels. It is worthy of clinical promotion.