关键词: 右胸入路；左胸入路；食管癌；肺功能；并发症

Abstract: Objective To observe the effects of different surgical approaches on the complications and tumor markers of patients undergoing radical resection of esophageal cancer.Method A prospective study was conducted on 100 patients with esophageal cancer who underwent radical surgery in our hospital from October 2019 to October 2022.They were randomly divided into an observation group and a control group using a random number table method,with 50 patients in each group,he right thoracic approach was used in the observation group and the left thoracic approach was used in the control group.Perioperative indexes,inflammatory factors [Substance P (SP),hypersensitive C-reactive protein (hs-CRP),interleukin6 (IL-6)],tumor markers [cytokeratin 19 fragment antigen (CYFRA21-1),squamous cell carcinoma antigen (SCC-Ag) and carbohydrate antigen 199 (CA199)] and lung function of the two groups were compared before and after surgery Indicators [vital capacity (VC),forced vital capacity (FVC),and forced expiratory volume in the first second (FEV₁)] and complication rate.Result The operating time,blood loss,indwelling time,hospitalization time,and number of lymph node dissection in the observation group were (247.65±27.33) minutes,(211.82±25.49) ml,(6.97 ± 2.12) days,(16.11±3.81)days ,and (19.67±5.21),respectively,which were higher than those in the control group[(217.63±23.69)minutes,（175.67±22.13）ml,（5.43±1.80）days,（12.68±3.24）days,（15.45±4.12）] (P<0.05).On average,there was a significant increase in SP,hs CRP,and IL-6 levels in both groups 3 days after surgery (P<0.05).The levels of SP,hs CRP,and IL-6 in the observation group were (273.96±35.45) ng/L,(11.35±2.12) mg/L,and (8.19±1.67)μg/ml,respectively,which were lower than the control group [（298.33±38.42）ng/L,（14.29±2.68）mg/L,（10.35±1.82）μg/ml](P<0.05);One month after surgery,there was a significant decrease in CYFRA21-1,SCC-Ag,and CA199 in both groups (P<0.05),and in the observation group,the data of CYFRA21-1,SCC-Ag,and CA199 were (2.59±0.37)μg/L,(45.62±6.18) μg/L and (59.37±6.12) U/ml,respectively,which were lower than those in the control group [（3.12±0.43）μg/L,（60.27±7.35）μg/L,（63.28±6.49）U/ml](P<0.05);One month after surgery,there was a significant decrease in VC,FVC,and FEV₁ in both groups (P<0.05).However,the VC,FVC,and FEV₁ in the observation group were (67.21±8.69)%,(70.33±9.41)%,and (72.88±10.12)%,respectively,which were higher than those in the control group [（54.35±8.27）%,（61.65±8.79）%,（65.37±9.24）%](P<0.05).There was no significant difference in the incidence of complications between the two groups (P>0.05).Conclusion Both approaches can effectively treat esophageal cancer.Among them,the right chest approach can significantly improve the effect of lymph node dissection,inhibit inflammatory reactions,reduce tumor marker levels,and have less impact on lung function,without significantly increasing the risk of complications.However,the surgical time,bleeding volume,and postoperative recovery time are relatively long.Therefore,a suitable approach should be selected in clinical practice based on the patient’s actual situation.

Key words: right thoracic approach；left thoracic approach；esophageal cancer；lung function；complication