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Objective:To investigate the effect of antidepressant therapy on cellular immunity and quality of life of patients with depression after thoracoscopic radical resection of esophageal cancer.Methods:Between June 2015 to March 2019, our hospital during the period of line thoracoscope comorbid depressive patients, 186 cases of esophageal cancer radical, according to the indicator method were randomly divided into treatment group and the control group (n=93), the treatment group after surgery for antidepressant treatment, the control group did not give any postoperatively in patients with depressive drugs treatment, routine for psychological counseling. Self-rating Depression Scale SDS and Generic Quality of Life Inventory-74 (GQoli-74) were used to evaluate the changes of depression status and Quality of Life in 2 groups before and after treatment. Flow cytometry was used to detect the levels of CD 4+ and CD 8+ subsets in peripheral blood to evaluate the changes of immune system function in 2 groups before and after treatment. Results:After treatment, the SDS score of the treatment group was significantly lower than that before treatment, the difference was statistically significant( P<0.05), while the SDS score of the control group was not significantly changed before and after treatment, the difference was not statistically significant( P>0.05). After antidepressant treatment, CD 4+ and CD 4+ /CD 8+ levels in the immune system in the treatment group were significantly increased, and CD 8+ levels were significantly decreased, with statistical significance ( P<0.05), while CD 4+ , CD 8+ and CD 4+ /CD 8+ levels in the control group were not significantly changed before and after treatment. There was no significant difference ( P>0.05). After treatment, the body function, psychological function, social function, material state and total score of quality of life of patients in the treatment group were significantly improved compared with before treatment, the difference was statistically significant ( P<0.05), while the score of quality of life of patients in the control group was not significantly changed before and after treatment, the difference was not statistically significant ( P>0.05). Conclusion:Antidepressant therapy can significantly improve the depression status of postoperative esophageal cancer patients, and improve the immune system function and quality of life.
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@#Esophageal carcinoma is one of the most common malignant tumor, a serious threat to human health. In the early and middle esophageal carcinoma patients, surgery is the only expected treatment to cure esophageal carcinoma. Traditional surgery of esophageal cancer needs thoracotomy and laparotomy, which has great trauma and high incidence of complications. So surgeons are looking for a minimally invasive surgical methods alternative to traditional esophagectomy. Video-mediastinoscopy is used to free middle and upper esophagus, as a minimally invasive surgical method, it is used in radical resection of esophageal cancer gradually. This article reviews the recent progress and the related research results in the application of mediastinoscopy in the radical resection of esophageal cancer. It is found that mediastinoscopy assisted the radical resection of esophageal cancer is a safe and feasible operation. It provides a feasible treatment option for early and middle stage esophageal cancer patients with pulmonary insufficiency who can not be resected by thoracoscopy.
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Objective To observe the clinical responses and hemodynamic changes of single chamber endotracheal intubation general anesthesia applied to thoracoscopic resection of esophageal carcinoma under carbon dioxide pneumothorax. Method Sixty [ASA I ~ II, NYHA I ~ II, hight (148.57 ± 10.95) cm, weight (40.52 ± 3.97) kg] patients who were light weight, short height, and underwent thoracoscopic resection of esophageal carcinoma in pneumothorax with filling carbon dioxide under general anesthesia of tracheal intubation with single lumen were selected. CO2gas (6 ~ 8 L/min) was slowly inserted into the operative side thoracic cavity to maintain intrathoracic pressure 6 ~ 8 mmHg (1 mmHg=0.133 kPa), heart rate (HR), blood pressure (BP), central venous pressure (CVP), pulse oxygen saturation (SpO2), airway pressure (PaW), partial pressure of end-tidal carbon dioxide (PETCO2) and other indicators and so on, were collected at the 5 minutes before artificial pneumothora (T1), and at the 5 minutes (T2), 15 minutes(T3), 30minutes (T4), 60 minutes (T5), 100 minutes (T6) after artificial pneumothorax, and 10 minutes at the end of thoracic operation (T7), Samples of arterial blood gases were obtained at the same time. Results All cases were successfully completed by thoracoscopic surgery, significant arrhythmias and severe complications were not found at each time point; After CO2pneumothorax, HR, CVP, PaW, PETCO2and PaCO2at T2~ T6increased significantly than those at T1(P < 0.05); but BP, Arterial oxygen pressure (PaO2) and blood pH value decreased significantly at T2~ T6than those at T1(P < 0.05); SpO2at T3and T4was significantly lower than that at T1(P < 0.05), Although SpO2also decreased at T5and T6, there was no significant differences comparing to at T1(P > 0.05). After T7, most of the remaining indicators were restored to the base level excep that CVP remains high. Conclusion When patients with low weight and short stature underwent tracheal intubation under single lumen anesthesia for thoracoscopic resection of esophageal cancer under carbon dioxide pneumothorax, their hemodynamics were relatively stable,and all the indexes of respiration and arterial blood gas were within the acceptable range, It was a feasible, relatively safe method of anesthesia for such patients who could enjoy thoracoscopic techniques.
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40 patients to undergo video-assisted thoracoscopic radical resection of esophageal carcinoma through right thoracotomy were randomly divided intogroup of horizontal position (group S) and group left lateral position (group L),and with 20 patients in each group respectively.The bronchial occluder was placed into the right bronchia guided by fiber bronchoscope after tracheal intubation following the anesthesia induction in each group,while the occluder of group S was placed under the left lateral position,while that of group L was inserted under horizontal position.Then,we observed including the occluder displacement,the number of the use of fiber bronchoscope and the satisfaction degree of pulmonary collapse in the two groups.The differences of the occluder displacement number under lateral position,the number of the use of fiber bronchoscope in the two groups were statistically significant,while there was no statistical difference in the satisfaction degree of pulmonary collapse between the two groups.The fiber bronchoscope-guided bronchial occluder placement into the right bronchia under left-lateral position is able to prevent the displacement during lateral position process and reduce the number of use of fiber bronchoscope,which is deserved to be recommended into the clinical practice.
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Objective To investigate the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on the lung injury during one-lung ventilation (OLV) in the patients undergoing thoracic surgery. Methods Eighty ASA physical status I or Ⅱ patients, scheduled for elective radical operation for esophageal cancer, were randomly divided into 2 groups(40 patients each group) using a random number table: control group and RIPC combined with dexmedetomidine group (ORD group). In ORD group,10 min after endotraeheal intubation, RIPC was induced by 3 cycles of 5 min lower extremity ischemia followed by 5 min reperfusion, and at the same time a loading dose of dexmedetomidine 1.0 μg/kg was infused intravenously over 15 min and then dexmedetomidine was infused at a rate of 0.5 μg/(kg·h) until the end of operation. At 0, 30 min, 1 h and 2 h of OLV(T1-4), blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α (TNF-α), interleukin (IL)-1βand IL-10.Oxygenation index and respiratory index were calculated. Exhaled breath condensate was collected at T1, T3 and T4, and the pH value was measured. Results The respiratory index at T2-4 in 2 groups were significantly higher than those at T1, control group: 1.16 ±0.12, 1.02 ±0.10 and 0.97±0.12 vs. 0.49±0.06, ORD group: 0.84±0.15, 0.72±0.12 and 0.65±0.10 vs. 0.48±0.08, there were statistical differences (P<0.05). The oxygenation index at T2-4 in 2 groups were significantly lower than those at T1, control group: (287.1±21.8), (306.8±35.2) and (312.9±25.5) mmHg (1 mmHg=0.133 kPa) vs. (426.5±39.0) mmHg, ORD group: (335.0±34.7), (341.1±41.3) and (359.1±38.8) mmHg vs. (433.6±23.8) mmHg, there were statistical differences (P<0.05). Compared with control group, the respiratory index at T2-4 in ORD group were elevated, the oxygenation index at T2-4 in ORD group were depressed, there were statistical differences (P<0.05). The TNF-α and IL-1β at T3-4 in 2 groups were significantly higher than those at T1, control group: (31.4±6.7) and (38.3±7.2) μg/L vs. (16.2±5.1) μg/L, (7.2±1.6) and (12.3±4.2) μg/L vs. (3.0±0.7) μg/L, ORD group: (21.7±5.4) and (23.4±5.1) μg/L vs. (16.3±4.7) μg/L, (4.8±0.9) and (6.3±1.6) μg/L vs. (2.9±0.8) μg/L, there were statistical differences (P<0.05). The pH value of exhaled breath condensate at T3-4 in 2 groups were significantly lower than those at T1, control group: 6.41±0.23 and 6.33±0.21 vs. 6.93±0.35, ORD group: 6.79±0.30 and 6.74±0.33 vs. 7.07±0.22, there were statistical differences (P<0.05). The IL-10 at T4 in 2 groups were significantly higher than those at T1, control group:(30.6±6.3) μg/L vs. (19.2±5.3) μg/L, ORD group: (41.3±5.2) μg/L vs. (19.5±4.9) μg/L, there were statistical differences (P<0.05). Compared with control group, the TNF-α and IL-1β at T3-4 in ORD group were depressed, the pH value of exhaled breath condensate at T3-4 in ORD group were elevated, the IL-10 at T4 in ORD group was elevated, there were statistical differences (P<0.05). Conclusions RIPC combined with dexmedetomidine can inhibit inflammatory responses and reduce airway acidification, thus attenuate the lung injury during OLV in the patients undergoing thoracic surgery.