两种甲状腺手术对良性甲状腺肿块患者免疫功能、炎症反应水平的影响

Effects of EAT and TETThyroid Surgery on Immune Function and Inflammatory Response in Patients

目的探讨腔镜辅助小切口(endoscopic-assistant thyroidectomy,EAT)、完全腔镜甲状腺切除术(totally endoscopic thyroidectomy,TET)治疗良性甲状腺肿块对患者免疫功能、炎症反应的影响。方法选取2016年6至12月我院收治的90例良性甲状腺肿块患者,采用随机数字表法分为EAT组和TET组各45例,分别于术前、术后不同时间点测量两组患者的手术时间、术后第1天引流量、住院时间、血清免疫球蛋白、外周血T淋巴细胞亚群、血清细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)的水平。结果EAT组的手术时间短于TET组(P<0.05);EAT组的术后第1d引流量、住院时间差异无统计学意义(P>0.05);术前、术后1天、术后3天、术后5天,EAT组和TET组患者的血清Ig A、Ig G、Ig M、CD3+、CD4+、CD8+水平组间比较,差异无统计学意义(P>0.05);两组患者术后1天、术后3天的血清Ig A、Ig G、Ig M、CD3+、CD4+水平较本组术前均降低,CD8+水平较术前均显著的升高,差异有统计学意义(P<0.05);术后1天、术后3天、术后5天,EAT组患者的血清IL-6、TNF-α、CRP水平均显著低于TET组,两组患者的血清IL-6、TNF-α、CRP水平在术后1天、术后3天较术前均显著的升高,差异有统计学意义(P<0.05)。讨论EAT和TET治疗良性甲状腺肿块均对患者的免疫功能造成影响,EAT手术对患者的炎症反应影响更小。

Objective To investigate the endoscope assisted small incision(EAT),totally endoscopic thyroidectomy(TET)treatment on the immune function of patients with benign thyroid mass and inflammatory reaction.Methods We selected 90 cases(June 2016 to December 2016)in our hospital in patients with benign thyroid mass,were randomly divided into EAT group and TET group with 45 cases in each group,respectively,before and after surgery at different time points of measurement of serum immunoglobulin,two groups of patients with operative time,drainage volume on the first day after operation,length of hospital stay,peripheral blood T lymphocyte subsets and serum interleukin-6(IL-6),tumor necrosis factor alpha(TNF-alpha),C reactive protein(CRP)level.Results The operation time of EAT group was shorter than that of TET group(P<0.05);there was no significant difference in drainage volume and hospitalization time on the first day after operation between EAT group and TET group(P>0.05).5 days before surgery,1 days,3 days after surgery,after surgery,EAT group and TET group of patients with serum Ig A,Ig G,Ig M,CD3+,CD4+and CD8+levels between groups,the difference was not statistically significant(P>0.05);the two groups of patients after 1 and 3 days after the operation the serum Ig A,Ig G,Ig M,CD3+,CD4+level than the preoperative group were lower(P<0.05),the levels of CD8+were significantly increased(P<0.05);5 days after 1 days,3 days after surgery,after surgery,group EAT patients with serum IL-6,TNF-alpha,CRP level were significantly lower than TET group(P<0.05),two patients with serum IL-6,TNF-alpha,CRP levels after 1 and 3 days after operation were significantly higher than that before operation(P<0.05).Conclusion EAT and TET treatment of benign thyroid mass have an impact on the immune function of patients,EAT surgery on the patient’s inflammatory response is less affected.