摘要目的 探讨小切口Ivor-Lewis食管切除术对食管癌患者围手术期急性时相反应的影响.方法 采用非随机临床对照研究的方法,按照患者意愿,将48例胸中下段食管鳞癌患者分为小切口Ivor-Lewis食管切除术组(25例)和传统手术组(23例).于术前1 d、术后第18 h、术后第3天、术后第7天检测两组患者血清中急性时相蛋白[C反应蛋白(CRP)、触珠蛋白(HPT)、α1-酸性糖蛋白(α1-AG)、铜蓝蛋白(CER)、转铁蛋白(TRF)、β2微球蛋白(β2-MG)、白蛋白(ALB)]和细胞因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]的含量,并进行比较.结果 手术前后各时点,两组患者血清中各急性时相蛋白和IL-6的含量差异均无统计学意义(均P＞0.05).术后第18 h,两组患者血清中CRP和α1-AG的含量均较术前明显增高(均P＜0.05),直至术后第7天仍显著高于术前水平(均P＜0.05).术后各时点,两组患者血清中ALB和TRF的含量均较术前明显降低(均P＜0.05).CER和β2-MG的含量在手术前后均无明显变化(均P＞0.05).术后第18 h,小切口组患者血清中TNF-α的含量明显高于传统组(P＜0.05);其余各时点,两组差异均无统计学意义(均P＞0.05).结论 与传统手术比较,小切口Ivor-Lewis食管切除术并未明显减轻患者对手术创伤的应激反应.在不改变手术实质的前提下,要达到手术方式本身对机体创伤的微创化,切口大小并不是关键因素,还需要从与手术相关的各个环节中寻找新的有效途径.

abstractsObjective To explore the effect of minimally invasive Ivor-Lewis esophagectomy on acute phase responses in patients with esophageal carcinoma. Methods Forty-eight patients with middle or low thoracic esophageal carcinoma underwent Ivor-Lewis esophagectomy. The patients were divided into small incision group (n =25) and conventional group (n =23) according to the patients' will. Serum levels of acute phase proteins C reactive protein (CRP), haptoglobin (HPT), α1-acid glycoprotein (α1-AG),ceruloplasmin (CER), transferrin (TRF), β2-microglobulin (β2-MG), album protein (ALB),interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were measured and compared on 1st day before operation, at 18 hours as well as 3rd and 7th day after operation. Results There was no significant difference in all the acute phase proteins indicators and IL-6 between the small incision and conventional groups at each time points after operation (P＞0.05). In both groups the levels of CRP, α1-AG and HPT were significantly higher after operation than before operation(P＜0.05).The levels of ALB and TRF were significantly lower after operation than before operation (P＜0.05). The levels of CER and β2-MG were not significantly different during perioperative period (P＞0.05). The level of TNF-α was significantly higher in the small incision group than that in the conventional group at the 18 hours postoperationally (P＜0.05), and were not significantly different on the other time points between the two groups ( P＞0.05). Conclusion Compared with conventional operation, the small incision Ivor-Lewis esophagectomy do not significantly alleviate the stress of the surgical trauma in patients. Unchanging the essence of operation, if one is trying to minimize the stress caused by surgery on patients, the key factor is not the size of incision. An effective approach should be found in other operation-related factors.