胸腔镜术与右侧开胸术对中早期食管癌患者微转移相关因子水平影响的随机对照研究

目的:比较电视胸腔镜手术(VATS)与右侧开胸手术治疗中早期食管癌的临床疗效以及对患者血清微转移相关因子的影响。方法:选取60例食管癌患者作为研究对象,根据术式将其随机分为开胸对照组(30例)和VATS术组(30例),分析和比较两组患者的手术时间、术中出血量、下床活动时间及术后并发症发生率,并分别检测和比较两组手术前后胸腔灌洗液脱落肿瘤细胞标志CK19、CK20的m RNA水平以及血清中IL1-β和HMGB1的水平。结果:与开胸组相比,VTSA组的手术出血量、术后出院时间均明显少于或短于对照组(P0.05),且其术后24 h、72 h胸腔引流液及外周血术后3 d、7 d的IL-1β水平均低于开胸组(P0.05),而仅术后24 h的胸腔引流液HMGB1水平低于开胸组(P0.05),两组其它时点HMGB1水平比较均没有统计学差异(P0.05)。两组术后CK19、CK20的m RNA水平比较没有统计学差异(P0.05)。结论:与传统开胸手术相比,VATS辅助下的食管癌根治术不仅具有患者恢复快的特点,而且对于手术引起的转移相关因子较低,值得临床推广应用。

Micrometastases Related Factors of Patients Following Esophageal Surgery for Esophageal Cancers: a Comparative Study between Video-assisted Thoracoscopic Surgery and Right Thoracotomy

Objective:To compare the clinical efficacy of video assisted thoracoscopic surgery (VATS) and the levels of micrometastases related factors of esophageal-resection patients.Methods:A total of 60 pa- tients with early esophageal cancer who underwent either a VATS (30) or a thoracotomy (30) were recruited for this study, whose clinical efficacies(operative time, bleeding, complications and hospitalization time ) were analyzed. The blood and pleural fluid samples of the participants were taken preoperatively and at post-operatively 24/72h (for pleural lavage) or 3/7 day (for blood) to analyze the CK19/20 mRNA levels in tumor shedding cells by Q-PCR and the protein levels of IL1-beta and HMGB1 in blood or pleural fluid samples by ELISA.Results:Compared with the thoracotomy group, patients in the VATSgroup lost significantly less blood, and got quicker recovery (P<0.05). Both IL1-beta and HMGB1 concentrations in blood and chest drainage fluid of patients in VATS group were significantly lower than those in the thoracotomy control group (P<0. 05). No significant difference was found between two groups in the mRNA levels of CK19 and CK20 in chest drainage fluid samples (P>0.05).Conclusion:Compared with the traditional thoracotomy approach, VATS tu- mor esophagectomy could promote the recovery, and had fewer impact on the micrometastases related factors, which it was worthy of clinical popularization.