全腔镜与开放食管癌切除术对患者术后早期肺功能影响比较

目的 探讨全腔镜与开放食管癌切除手术对患者术后早期肺功能的影响.方法 将61例食管癌手术患者随机分为全腔镜组(胸腹腔镜联合行食管癌切除手术组,32例)及开放组(经右胸、上腹及左颈三切口食管癌切除手术组,29例).分别于术前1d,术后第5及10天测定肺通气功能1秒用力呼气容积(FEV1)、用力肺活量(FVC)及血气分析,记录术后第1～5天疼痛评分及肺部并发症发生情况.结果 两组术前FEV1、FVC及血气分析差异均无统计学意义(均P＞0.05).术后第5及10天,两组FEV1及FVC均有不同程度的降低,以实测值/术前预计值作为比较参数,全腔镜组降低程度均小于开放组(均P＜0.05),术后第10天血氧分压(PaO2)及动脉血氧饱和度(SaO2)全腔镜组均高于开放组(均P＜0.05).术后第1～5天疼痛评分全腔镜组均低于开放组,其中术后4d内疼痛评分差异均有统计学意义(均P＜0.05).全腔镜组术后肺部并发症发生率低于开放手术组(P＜0.05).结论 胸腹腔镜联合行食管癌手术对患者术后早期肺功能影响相对较小,能降低术后肺部并发症发生率.

Comparison of early postoperative pulmonary function In patients with esophageal cancer after esophagectomy via full-endoscopic or open surgery

Objective To investigate the changes and influence factors of early postoperative pulmonary function in patients esophageal cancer after esophagectomy by full endoscopic or open surgery,and to explore the relative factors for postoperative pulmonary complications.MethodsFixty-one patients with esophageal cancer who had undergone esophagectomy surgery were randomly divided into two groups.Thirty-two cases who undergone minimally Invasive esophagectomy(MIE) were in the MIE group,and the other 29 cases who undergone open three-field esophagectomy were in the open group.Pulmonary function,including forced vital capacity(FVC),forced expiratory volume in 1 second(FEV1) were measured one day before operation and five and ten days after operation,and arterial blood gas analyses were performed during the same period.Meanwhile,pain scores on the first to the fifth day after surgery and the incidence of pulmonary complications were recorded as well.ResultsThere were no statistical differences in FEV1,FVC and arterial blood gas analysis between the two groups(P>0.05).On the 5th and 10th postoperative days,FEV1,FVC of two groups were decreased in varying degrees,but the MIE group decreased less than the open group(P <0.05).Postoperative PaO2,SaO2 of MIE group were better than those of the open group,and on the 10th postoperative day,there were significantly different(P <0.05).During the first 5 days after operation,pain scores of MIE group lower than those of open surgery group,and on the first to the fourth day after surgery,postoperative pain were significantly different(P<0.05).Incidence of postoperative pulmonary complications of MIE group was lower than that of open surgery group(P<0.05).ConclusionsTinimally Invasive esophagectomy had less influence on early postoperative pulmonary function,and can relatively reduce the incidence of pulmonary complications after surgery.