胸腔镜手术与小切口开胸肺切除术后细胞因子反应的随机对照研究

Cytokine Responses after Lobectomy:A Prospective Randomized Comparison of Video-assisted Thoracoscopic Surgery and Minimal Incision Thoracotomy

背景与目的:细胞因子在诱导急性期炎症反应及免疫反应中起重要作用,能否通过微创入路手术减少细胞因子的释放,减轻术后急性期反应和免疫抑制是肿瘤外科治疗关心的问题。本研究希望通过前瞻性随机对照研究,比较电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)与小切口开胸(minimal incision thoracotomy,MIT)肺切除术治疗临床早期非小细胞肺癌(non-small cell lung cancer,NSCLC),对比两种术式术后的细胞因子水平。方法:从2004年3月～2006年12月有47例CT提示为临床早期NSCLC、肿物直径≤6cm、符合入组条件的患者被随机分为VATS组(24例)和MIT组(23例),VATS组有2例患者因术中不能控制的出血和胸膜广泛粘连转为开胸手术而被剔除,MIT组1例因术中输血被剔除。使用流式微球分析技术(cytometric bead array,CBA)测定两组患者术前、术后4、24、48h血浆中肿瘤坏死因子(tumor necrosis factor-α,TNF-α),白介素-2(interleukin-2,IL-2)、IL-4、IL-6和IL-10的浓度。结果:术后两组患者TNF-α、IL-2和IL-4的血浆浓度均较低,差异无统计学意义。术后4h两组患者IL-6和IL-10均达峰值浓度。其中IL-6峰值浓度VATS组(91.0±63.9)ng/L,MIT组(84.2±53.1)ng/L,IL-10峰值浓度VATS组(12.6±8.1)ng/L,MIT组(16.3±11.2)ng/L,两组间差异无统计学意义(P=0.732和P=0.235)。重复测量数据的方差分析显示两组间4个时间点IL-6和IL-10的浓度差异均无统计学意义(F=0.143,P=0.708和F=0.000,P=0.996)。结论:胸腔镜手术和小切口开胸肺切除术后患者细胞因子反应无差异,其临床意义有待进一步研究。

BACKGROUND ＆ OBJECTIVE： The cytokine network plays a pivotal role in inducing acute-phase inflammatory and immunologic responses to surgical trauma. Whether lesser release of cytokines by mini-invasive operation can reduce acute-phase responses and better preserve immune functions needs to be explored. This prospective randomized study was to compare the effects of video-assisted thoracoscopic surgery （VATS） and minimal incision thoracotomy （MIT） on serum levels of cytokines after lobectomy for clinical early stage non-small cell lung cancer （NSCLC）. METHODS： From Mar. 2004 to Dec. 2006, 47 consecutive patients with early stage NSCLC （tumor size was ≤6 cm as showed on CT scan） were recruited and randomized into VATS group （n=24） and MIT group （n=23）. Two patients in VATS group were excluded for conversion to posterolateral thoracotomy because of uncontrolled bleeding and dense pleural adhesion; 1 in MIT group was excluded for intraoperative blood transfusion. Serum levels of tumor necrosis factor-α（TNF-α） , interleukin （IL）-2, IL-4, IL-6, and IL-10 were measured by cytometric bead array （CBA） before operation and at 4, 24, and 48 h after operation. RESULTS： The serum levels of TNF-α, IL-2 and IL-4 were low after operation in both groups, and there were no significant differences between the 2 groups. Both IL-6 and IL-10 reached peak serum concentration （Cmax） at 4 h after operation： the Cmax of IL-6 was （ 91.0±63.9） ng /L in VATS group and （ 84.2±53.1） ng /L in MIT group （ P= 0.732） ; the Cmax of IL-10 was （12.6±8.1） ng /L in VATS group and （16.3± 11.2） ng /L in MIT group （P=0.235）. The changes in serum concentration of IL-6 and IL-10 in the 2 groups among the 4 time points were not significant （ F=0.143, P=0.708 for IL-6; F=0.000, P=0.996 for IL-10） . CONCLUSIONS： Compared with MIT, VATS major lung resection can^t reduce postoperative release of cytokines. The clinical significance of these findings remains to be fully elucidated.