CAJ | 학술논문

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.
목적 탐토흉복강경연합하식관암수술대환자술후조기폐공능적영향급기여폐부병발증적관계.방법 2009년9월지2010년12월장61례식관암수술환자수궤분위량조,기중흉복강경연합하경우흉、상복、좌경식관암절제수술조(강경조)32례,전통삼절구경우흉、상복、좌경식관암절제수술조(개방조)29례.분별우술전1d、술후제5천、술후제10천측정제일초용력호기량(FEV1)、용력폐활량(FVC),병행혈기분석,기록술후제1～5천동통평분급폐부병발증발생정황.결과 량조술전FEV1점예계치적백분비(FEV1％)、FVC점예계치적백분비(FVC％)급혈기분석결과차이무통계학의의(t=-1.608 ～0.709,P=0.113 ～0.481).강경조술후제10천FEV1％、FVC％、PaO2、SaO2우우개방조[FEV1％∶77％±17％비53％±13％,t =6.241,P=0.000;FVC％:78％±13％비57％±16％,t=5.549,P=0.000; PaO2:(87±9)mmHg비(79±14) mmHg,t=2.477,P =0.017;SaO2∶96.1％±3.3％비94.3％±2.4％,t=2.313,P=0.024；1 mmHg=0.133 kPa].강경조술후제1～5천동통평분저우개방조,기중술후4d내동통차이유통계학의의(t=-4.398～-1.815,P=0.000～0.049).강경조술후폐부병발증발생솔저우개방수술조(6/32비12/29,x2=3.745,P=0.049).결론 흉복강경연합하식관암수술대환자술후조기폐공능영향교소,술후폐부병발증발생솔상대교저.
Objectives 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.