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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(P<0.05),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(P<0.05),而仅术后24 h的胸腔引流液HMGB1水平低于开胸组(P<0.05),两组其它时点HMGB1水平比较均没有统计学差异(P>0.05)。两组术后CK19、CK20的m RNA水平比较没有统计学差异(P>0.05)。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。
Objective: To compare the clinical efficacy of video-assisted thoracoscopic surgery (VATS) and right-sided thoracotomy in the treatment of early-stage esophageal cancer and its effect on serum micrometastasis-related factors. Methods: Sixty patients with esophageal cancer were selected as study subjects. They were randomly divided into thoracotomy group (30 cases) and VATS group (30 cases) according to surgical procedure. The operative time, intraoperative bleeding Amount of bedtime ambulation and postoperative complications were detected. The mRNA levels of CK19, CK20 and IL-|ÊB and serum HMGB1 were detected and compared before and after thoracic lavage. Results: Compared with the thoracotomy group, the amount of bleeding and the time of postoperative discharge in the VTSA group were significantly shorter than those in the control group (P <0.05), and the rates of drainage and peripheral blood in the VTSA group at 24 h and 72 h after operation The level of IL-1β in postoperative 3 d and 7 d was lower than that in thoracotomy group (P <0.05), but the level of HMGB1 in pleural fluid 24 h after operation was lower than that in thoracotomy group (P <0.05) There was no significant difference in the level of HMGB1 between the two groups (P> 0.05). The mRNA levels of CK19 and CK20 in the two groups had no statistical difference (P> 0.05). Conclusion: Compared with traditional thoracotomy, VATS-assisted radical resection of esophageal cancer not only has the characteristics of rapid recovery of patients, but also has low metastasis-related factors and is worthy of clinical application.