胸腹腔镜联合根治术治疗老年食管癌患者的临床疗效及对免疫功能的影响

Clinical effect of thoracic and laparoscopy combined radical operation in treatment of elderly patients with esophageal cancer and its impact on immune function

摘要:

目的 探讨胸腹腔镜联合根治术治疗老年食管癌患者的疗效及对患者外周血自然杀伤细胞（NK cell）和T淋巴细胞亚群（CD4⁺、CD8⁺和CD4⁺/CD8⁺）的影响。方法 选取该院2017年1月－2019年1月收治的老年食管癌患者80例。其中，2017年1月－2018年1月实施传统食管癌根治术治疗的患者为对照组（n = 40），2018年2月－2019年1月实施胸腹腔镜联合根治术治疗的患者为观察组（n = 40）。比较两组患者手术指标、预后指标、术前及术后7 d免疫指标（NK cell、CD4⁺、CD8⁺和CD4⁺/CD8⁺）变化、术后并发症、术后1年生存率、复发率和健康调查量表36（SF-36）评分情况。结果 观察组手术时间、切口长度、拔管时间、疼痛时间和住院时间均较对照组短，术后胸腔引流量和术中出血量较对照组少（P < 0.05）；术后并发症总发生率（12.50%）低于对照组（35.00%），SF-36评分［（79.37±5.94）分］高于对照组［（72.66±7.78）分］，两组患者比较，差异均有统计学意义（P < 0.05）；两组患者术后7 d NK cell、CD4⁺和CD4⁺/CD8⁺水平均较术前下降（P < 0.05），观察组NK cell、CD4⁺和CD4⁺/CD8⁺水平高于对照组（P < 0.05）；两组患者淋巴结清扫数目［观察组（11.67±2.07）个，对照组（11.02±2.15）个］、术后1年生存率（观察组82.50%，对照组72.50%）和复发率（观察组20.00%，对照组22.50%）比较，差异均无统计学意义（P > 0.05）。结论 胸腹腔镜联合根治术可有效保护老年食管癌患者的免疫功能，降低术后并发症发生率，改善患者生活质量，近期疗效满意。

Abstract:

Objective To explore the thoracic and laparoscopy combined radical operation on esophageal cancer in the elderly and the effect on peripheral blood natural killer cells (NK cell) and T-lymphoid subsets (CD4⁺, CD8⁺ and CD4⁺/CD8⁺).Method 80 cases of elderly patients with esophageal cancer from January 2017 to January 2019 were selected. Among them, the patients treated with traditional radical esophagectomy from January 2017 to January 2018 as the control group (n = 40), and the patients treated with thoracoscopic combined radical esophagectomy from February 2018 to January 2019 as the observation group (n = 40). The operative indexes, prognosis indexes, the changes of immune indexes (NK cell, CD4⁺, CD8⁺ and CD4⁺/CD8⁺) before and 7 days after operation, complications after operation, 1-year survival rate after operation, recurrence rate and 36-item short form health survey (SF-36) scale of the two groups were compared.Result The operation time, incision length, extubation time, the pain days and hospitalization time in the observation group were shorter than those in the control group, postoperative thoracic drainage volume and intraoperative bleeding volume less than that in the control group (P < 0.05); The total incidence of postoperative complications in the observation group (12.50%) was lower than that in the control group (35.00%), and the SF-36 scale [(79.37 ± 5.94) vs (72.66 ± 7.78)] was higher than that in the control group, the differences were statistically significant (P < 0.05); The levels of NK cell, CD4⁺ and CD4⁺/CD8⁺ in the two groups were all decreased 7 days after operation (P < 0.05), the levels of NK cell, CD4⁺ and CD4⁺/CD8⁺ in the observation group were higher than those in the control group (P < 0.05); There were no significant difference in the lymph node dissection number, the 1-year survival rate and the recurrence rate between the two groups [(11.67 ± 2.07) vs (11.02 ± 2.15), 82.50% vs 72.50%, 20.00% vs 22.50%) (P > 0.05).Conclusion Thoracic and laparoscopy combined radical operation can effectively protect the immune function of elderly patients with esophageal cancer, reduce postoperative complications, improve the quality of life, and the short-term effect is satisfactory.