摘要
目的 探讨改良术中配合方案在胸腔镜下三切口食管癌根治术患者中的应用效果.方法 根据干预方法的不同将106例胸腔镜下三切口食管癌根治术患者分为常规组(n=49,常规术中配合方案)和改良组(n=57,改良术中配合方案).比较两组患者的手术相关指标、应激反应指标[白细胞介素(IL)-6、IL-1β、IL-8、C反应蛋白(CRP)]、肺功能指标[第1秒用力呼气量占预计值百分比(FEV1%)、用力呼气量占预计值百分比(FEV%)、用力肺活量占预计值百分比(FVC%)、肺活量占预计值百分比(VC%)、最大自主通气量占预计值百分比(MVV%)]、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]及并发症发生情况.结果 改良组患者手术时间、首次排气时间、住院时间均短于常规组,差异均有统计学意义(P﹤0.05).术后24 h,两组患者IL-6、IL-1β、IL-8、CRP水平均高于本组术前,改良组患者IL-6、IL-1β、IL-8、CRP水平均低于常规组,差异均有统计学意义(P﹤0.05).出院前1天,两组患者MVV%、VC%、FVC%、FEV%、FEV1%均低于本组术前,改良组患者MVV%、VC%、FVC%、FEV%、FEV1%均高于常规组,差异均有统计学意义(P﹤0.05).出院前1天,改良组患者躯体功能、情绪功能、认知功能及总体健康状况评分均高于常规组,差异均有统计学意义(P﹤0.05).改良组患者术后并发症总发生率低于常规组,差异有统计学意义(P﹤0.05).结论 改良术中配合方案应用于胸腔镜下三切口食管癌根治术患者,可提高手术效率,促进患者术后恢复,减轻应激反应,改善肺功能和生活质量,降低并发症发生率.
Abstract
Objective To explore the application effect of modified intraoperative coordination plan in patients under-going thoracoscopic three-incision radical resection of esophageal cancer.Method According to different intervention methods,106 patients with thoracoscopic three-incision radical resection for esophageal cancer were divided into routine group(n=49,routine intraoperative coordination plan)and modified group(n=57,modified intraoperative coordination plan).The surgical related indexes,stress response indexes[interleukin(IL)-6,IL-1β,IL-8,C-reactive protein(CRP)],pulmonary function indexes[percentage of predicted forced expiratory volume in one second(FEV1% ),percentage of pre-dicted forced expiratory volume(FEV% ),percentage of predicted forced vital capacity(FVC% ),percentage of predicted vital capacity(VC% ),percentage of predicted maximal voluntary ventilation(MVV% )],quality of life[European Organi-zation for Research and Treatment of Cancer quality of life questionnaire core 30(EORTC QLQ-C30)]and the occur-rence of complications were compared between the two groups.Result The operation time,first exhaust time and hospi-tal stay in modified group were shorter than those in routine group,and the differences were statistically significant(P<0.05).Twenty-four hours after surgery,the levels of IL-6,IL-1β,IL-8 and CRP in both groups were higher than those be-fore surgery,and the levels of IL-6,IL-1β,IL-8 and CRP in modified group were lower than those in routine group,and the differences were statistically significant(P<0.05).One day before discharge,the MVV%,VC%,FVC%,FEV% and FEV1% in both groups were lower than those before surgery,and the MVV%,VC%,FVC%,FEV% and FEV1% in modi-fied group were higher than those in routine group,and the differences were statistically significant(P<0.05).One day be-fore discharge,the scores of physical function,emotional function,cognitive function and general health status in modi-fied group were higher than those in routine group,and the differences were statistically significant(P<0.05).The total in-cidence of postoperative complications in modified group was lower than that in routine group,and the difference was sta-tistically significant(P<0.05).Conclusion The modified intraoperative coordination plan applied to patients undergoing thoracoscopic three-incision radical resection of esophageal cancer can improve the efficiency of surgery,promote postop-erative recovery,reduce stress response,improve lung function and quality of life,and reduce the incidence of complica-tions.
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