标题：全腔镜 Ivor-Lewis术对中下段食管癌患者氧化应激指标、胃肠功能及预后的影响

      作者：岳军 1，崔刘涛 1，张冲锋 1，牛瑞玲 1，徐林飞 2    1.驻马店市中医院心胸大血管外科，河南 驻马店 463000；2.河南省胸科医院骨科，河南 郑州 450000

      卷次： 2023年34卷9期

      【摘要】 目的 探讨全腔镜 Ivor-Lewis术对中下段食管癌患者氧化应激指标、胃肠功能及预后的影响。方法 回顾性分析2019年1月至2022年1月在驻马店市中医院行手术治疗的150例中下段食管癌患者的临床资料，根据手术方式不同分组，其中76例实施全腔镜 Ivor-Lewis术者纳入研究组，74例实施全腔镜McKeown术者纳入对照组。比较两组患者的手术一般情况、术前及术后 1 d、3 d的氧化应激反应[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)]、胃肠功能[胃动素(MTL)、胃泌素(GAS)、]、并发症及术后6个月的预后情况。结果 研究组患者的手术时间(206.53±33.54) min，明显短于对照组的(254.39±36.87) min，治疗费用(8.52±1.60)万元，明显低于对照组的(9.07±1.58)万元，差异均有统计学意义(P<0.05)；术后 1 d，研究组患者的GSH-Px、SOD、GAS、MTL水平分别为(104.69±17.24) U/mL、(92.27±10.328) U/mL、(57.39±7.21) ng/L、(110.28±10.79) ng/L，术后 3 d分别为(124.69±19.32) U/mL、(106.73±12.64) U/mL、(62.59±6.33) ng/L、(132.51±14.77) ng/L，均明显高于对照组术后1 d的(92.88±15.37) U/mL、(83.51±9.36) U/mL、(51.53±6.45) ng/L、(96.55±11.86) ng/L，术后 3 d的(110.73±18.31) U/mL、(95.77±11.58) U/mL、(55.28±7.14) ng/L、(112.49±15.11) ng/L，差异均有统计学意义(P<0.05)；术后1 d、3 d，研究组患者的MDA水平分别为(8.39±1.47) nmol/mL、(6.54±1.22) nmol/mL，明显低于对照组的(10.74±1.58) nmol/mL、(7.28±1.35) nmol/mL，差异均有统计学意义(P<0.05)；研究组患者的吻合口瘘和喉返神经损伤发生率分别为2.63%、5.26%，明显低于对照组的14.86%、16.22%，差异均有统计学意义(P<0.05)；术后6个月，两组患者转移、复发、病死发生率比较差异均无统计学意义(P>0.05)。结论 全腔镜 Ivor-Lewis术治疗中下段食管癌能缩短手术时间，减轻氧化应激反应，能促进术后胃肠功能恢复，且不会增加并发症、肿瘤转移、复发和死亡风险，但治疗费用高，会增加患者经济负担。
      【关键词】 食管癌；腔镜；Ivor-Lewis术；胃肠功能；氧化应激；预后
      【中图分类号】 R735.1 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1250—05

Effect of total endoscopic Ivor-Lewis operation on oxidative stress index, gastrointestinal function, and prognosisin patients with middle and lower esophageal cancer.
YUE Jun 1, CUI Liu-tao 1, ZHANG Chong-feng 1, NIU Rui-ling 1,XU Lin-fei 2. 1. Department of Cardiothoracic and Vascular Surgery, Zhumadian Traditional Chinese Medicine Hospital,Zhumadian 463000, Henan, CHINA; 2. Department of Orthopedics, Henan Provincial Chest Hospital, Zhengzhou 450000,Henan, CHINA
【Abstract】 Objective To investigate the effect of total endoscopic Ivor-Lewis operation on oxidative stress in-dex, gastrointestinal function, and prognosis in patients with middle and lower esophageal cancer. Methods From Janu-ary 2019 to January 2022, 150 patients with middle and lower esophageal cancer in Zhumadian Traditional Chinese Med-icine Hospital were selected as the study subjects. According to the surgical methods, the patients were divided into thestudy group (76 cases) and the control group (74 cases). The study group applied total endoscopic Ivor-Lewis surgery,and the control group applied total endoscopic McKeown surgery. The general conditions of operation, oxidative stressreaction before and at 1 day and 3 days after surgery [superoxide dismutase (SOD), glutathione peroxidase (GSH-Px),malondialdehyde (MDA)], gastrointestinal function [motilin (MTL), gastrin (GAS)], complications and prognosis of 6months after operation were compared between the two groups. Results The operation time of the study group was(206.53 ±33.54) min, significantly shorter than (254.39±36.87) min of the control group, and the treatment cost was(8.52±1.60) ×104 yuan, significantly higher than (9.07±1.58)×104 yuan of the control group (P<0.05). The levels ofGSH-Px, SOD, GAS, and MTL in the study group were (104.69±17.24) U/mL, (92.27±10.328) U/mL, (57.39±7.21) ng/L,(110.28 ± 10.79) ng/L at 1 day after surgery and (124.69 ± 19.32) U/mL, (106.73 ± 12.64) U/mL, (62.59 ± 6.33) ng/L,(132.51±14.77) ng/L at 3 days after surgery, which were higher than (92.88±15.37) U/mL, (83.51±9.36) U/mL, (51.53±6.45) ng/L, (96.55±11.86) ng/L at 1 day after surgery and (110.73±18.31) U/mL, (95.77±11.58) U/mL, (55.28±7.14) ng/L,(112.49±15.11) ng/L at 3 days after surgery in the control group (P<0.05). The MDA levels in the study group were(8.39 ±1.47) nmol/mL, (6.54 ±1.22) nmol/mL at 1 day and 3 days after surgery, which were significantly lower than(10.74±1.58) nmol/mL, (7.28±1.35) nmol/mL in the control group (P<0.05). The incidence of anastomotic leakage andrecurrent laryngeal nerve injury in the study group was 2.63% and 5.26%, which were significantly lower than 14.86%and 16.22% in the control group (P<0.05). Six months after operation, the incidence of metastasis, recurrence, and deathshowed no significant difference between the two groups (P>0.05). Conclusion Total endoscopic Ivor-Lewis opera-tion for middle and lower esophageal cancer can shorten the operation time, reduce oxidative stress reaction, promote therecovery of gastrointestinal function after operation, and will not increase the risk of complications, tumor metastasis, re-currence, and mortality, but it brings high treatment cost, which will increase the economic burden of patients.
      【Key words】 Esophageal cancer; Endoscope; Ivor-Lewis operation; Gastrointestinal function; Oxidative stress;Prognosis