摘要目的 探讨胸腹腔镜联合下食管癌手术对患者术后早期肺功能的影响及其与肺部并发症的关系.方法 2009年9月至2010年12月将61例食管癌手术患者随机分为两组,其中胸腹腔镜联合下经右胸、上腹、左颈食管癌切除手术组(腔镜组)32例,传统三切口经右胸、上腹、左颈食管癌切除手术组(开放组)29例.分别于术前1d、术后第5天、术后第10天测定第一秒用力呼气量(FEV1)、用力肺活量(FVC),并行血气分析,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占预计值的百分比(FEV1％)、FVC占预计值的百分比(FVC％)及血气分析结果差异无统计学意义(t=-1.608 ～0.709,P=0.113 ～0.481).腔镜组术后第10天FEV1％、FVC％、PaO2、SaO2优于开放组[FEV1％∶77％±17％比53％±13％,t =6.241,P=0.000;FVC％:78％±13％比57％±16％,t=5.549,P=0.000; PaO2:(87±9)mmHg比(79±14) mmHg,t=2.477,P =0.017;SaO2∶96.1％±3.3％比94.3％±2.4％,t=2.313,P=0.024；1 mmHg=0.133 kPa].腔镜组术后第1～5天疼痛评分低于开放组,其中术后4d内疼痛差异有统计学意义(t=-4.398～-1.815,P=0.000～0.049).腔镜组术后肺部并发症发生率低于开放手术组(6/32比12/29,x2=3.745,P=0.049).结论 胸腹腔镜联合下食管癌手术对患者术后早期肺功能影响较小,术后肺部并发症发生率相对较低.

abstractsObjectives To investigate the influence of combined thoracoscopic and laparoscopic esophagectomy for early postoperative pulmonary function,and to study the relative factors for postoperative pulmonary complications.Methods From September 2009 to December 2010,61 patients with esophageal cancer had undergone esophagectomy surgery,of which 32 patients had undergone combined thoracoscopic and laparoscopic esophagectomy (CTLE group ),and 29 patients had undergone open three-field esophagectomy (open group).Pulmonary function,including forced vital capacity ( FVC ),forced expiratory volume in 1 second ( FEV1 ) were measured on the 1th preoperative day,5th and 10th postoperative day,and arterial blood gas analyses were performed during the same period.Meanwhile,pain scores and other potentially relevant factors were recorded as well.Results Preoperative pulmonary function and arterial blood gas analysis,including FEV1％,FVC％,PaO2 in two groups had no significant difference (t =-1.608 to 0.709,P =0.113 to 0.481 ).On the 10th postoperative day,FEV1％,FVC％,PaO2,and SaO2 of two groups were significantly different (FEV1％ ∶ 77％ ±17％ vs.53％ ± 13％,t =6.241,P =0.000;FVC％:78％ ± 13％ vs.57％ ± 16％,t =5.549,P=0.000; PaO2:(87±9) mmHg vs.(79 ± 14)mmHg,t =2.477,P=0.017; SaO2∶ 96％ ±3％ vs.94％ ±2％,t =2.313,P=0.024; 1 mmHg =0.133 kPa).Pain score of CTLE group was lower than open group,and the scores of two groups had significant difference before the 5th day after surgery ( t =- 4.398 to - 1.815,P =0.000 to 0.049 ).Postoperative pulmonary complications of CTLE group was lower than open group ( 6/32 vs.12 / 29,x2 =3.745,P =0.049).Conclusions Combined thoracoscopic and laparoscopic esophagectomy has advantages on early postoperative pulmonary function.It can relatively reduce the incidence of pulmonary complications after surgery.