Clinical Efficacy Evaluation Of Artificial Pneumothorax Thoracoscopic Surgery For Esophageal Cancer And Analysis Of Factors Affecting Prognosis

Objective: To analyze the clinical effect of artificial pneumothorax thoracoscopic surgery for esophageal cancer and the factors affecting its prognosis were studied.Methods:.A retrospective analysis was performed on 113 cases of esophageal cancer who were admitted to the department of thoracic and cardiac surgery,zaozhuang city hospital,shandong province from January 2016 to December 2018 and underwent thoracoscopic laparoscopic combined minimally invasive Mc Keown surgery and met the inclusion criteria.According to whether artificial pneumothorax was used in surgery,51 cases were divided into the artificial pneumothorax group and 62 cases were divided into the traditional operation group.The perioperative blood gas changes of the two groups were compared.Operation condition during operation;Analysis of common postoperative complications and prognosis of postoperative patients.Finally,COX risk ratio model was used to analyze the main factors affecting the prognosis of esophageal cancer in the artificial pneumothorax group.Based on the analysis and discussion of the data obtained,the conclusion is drawn to determine the application value of using artificial pneumothorax in surgery.Results: 1.After the operation began to establish the artificial pneumothorax,the partial CO2 pressure of the patient increased to different degrees,and the partial O2 pressure decreased to different degrees after the artificial pneumothorax.After the artificial pneumothorax was stopped,it could be restored to the preoperative level.At the same time,the p H value of blood gas decreased after the artificial pneumothorax,and the difference was statistically significant compared with that before pneumothorax(P < 0.05).After the artificial pneumothorax was stopped,the blood gas p H value could be restored to the preoperative level.2.The average operation time of the artificial pneumothorax group was significantly shorter than that of the traditional operation group,and the difference was statistically significant(P=0.001).The number of lymph node dissection in the artificial pneumothorax group was significantly higher than that in the traditional operation group,and the difference was statistically significant(P=0.001).The intraoperative blood loss in the artificial pneumothorax group was significantly reduced compared with the traditional operation group(P=0.017).3.The incidence of pulmonary infection and recurrent laryngeal nerve injury in the artificial pneumothorax group was significantly lower than that in the traditional surgery group,with statistically significant differences(P < 0.05).There was no statistically significant difference between the two groups in the incidence of anastomotic fistula and the incidence of chylothorax(P > 0.05).4.In the artificial pneumothorax group,the indicators of inflammatory factor TNF-,il-6(ng/ml)showed a decreasing trend five days after the operation.The indicators of TNFand il-6(ng/ml)in the traditional surgery group also showed a decreasing trend five days after surgery,and the indicators of TNF-and il-6 in the traditional surgery group were significantly higher than those in the artificial pneumothorax group at the same time period,with statistically significant differences(P < 0.05).The postoperative stress response indicators of the two groups were higher than the normal level,in which WBC showed a trend of returning to the normal level day by day,and FT3 and FT4 showed a trend of returning to the normal level day by day,but there was no statistically significant difference between the two groups in the levels of WBC,FT3,FT4,CRP and cortisol at the same time period after surgery(P > 0.05).5.The results of the multivariate COX regression model showed that the factors influencing the survival rate of patients with esophageal cancer were clinical stage,pathological grade and regular radiotherapy and chemotherapy after swelling,among which the protective factors were regular postoperative radiotherapy and chemotherapy(OR=0.420 and 0.211).The 3-year cumulative survival rates of patients in the artificial pneumothorax group(group A)and the traditional surgery group(group B)were 86.5% and 83.2%,respectively,with no statistically significant difference(P > 0.05).Conclusion: The complications of esophageal cancer surgery are higher than those of other operations due to the factors such as large trauma,long operation time,and old age of patients,which are mainly manifested in respiratory pulmonary infection,anastomotic leakage,chylothorax,etc.Artificial pneumothorax thoracoscopy is safe and effective in the treatment of esophageal cancer,which can effectively shorten the operation time,reduce the side-effects on the recurrent laryngeal nerve and increase the number of lymph node dissections.Artificial pneumothorax technology has a smaller incidence of inflammatory reaction,which is beneficial to patients’ recovery and reduce complications.The main factors affecting the prognosis of patients are clinical stage,case grade,prognosis of lymph node metastasis and postoperative chemoradiotherapy.In summary,artificial pneumothorax technology is relatively safe and effective in the treatment of esophageal cancer,which is worthy of clinical rational choice.