Muscle-Sparing开胸术与后外侧开胸术对肺癌患者免疫功能影响

The researsh on immune function variation of Muscle-Sparing thoracotomy versus posterlateral thoracotomy in lung cancer

背景与目的:后外侧开胸术(posterolateral thoracotomy,PT)是肺癌手术常用术式,创伤较大。Muscle-Sparing开胸术(MST)是一种新的开胸方法。以往研究均着重于比较两种开胸术对手术时间的影响、手术后疼痛程度及恢复程度。考虑到肿瘤患者免疫功能低下,开胸术可导致机体免疫功能进一步下降,通过比较两种开胸术患者手术前后免疫功能的变化,了解两种开胸术之间的差别。方法:选取50例因肺癌而准备接受病肺切除患者。根据临床资料将患者分成MST组和PT组,每组各25例,并测定围术期免疫功能。比较两组患者在术前1天、术后第1、3和7天在细胞免疫、体液免疫和红细胞免疫之间的差异。结果:两组患者在分组和手术前免疫功能差异无显著性。手术后MST组患者免疫功能高于PT组,结果显示术后第1天MST组和PT组的NK细胞分别为19±7和13±9,CD4T细胞分别为29±9和23±9,RBC C3b R分别为6.7±2.3和4.8±2.3;RBC ICR分别为为15.4±2.9和13.6±2.8;术后第3天,MST组和PT组的CD4T细胞分别为35±9和29±10,IgG分别为10±3和8.8±2.2,IgA分别为2.1±1.1和1.6±0.9;RBC C3bRR分别为8.2±2.6和6±3;术后第7天MST组和PT组的IgG分别为11±3和9.4±2.3,以上每两组的数据差异均有显著性(P<0.05)。结论:MST与PT相比对机体免疫功能影响小,术后能使患者的免疫功能尽早得到恢复。

Background and purpose： Posterolateml thoracotomy（PT） is the most popular surgery approach for lung cancer but the operation has some side effects. The Muscle-Sparing thoracotomy（MST） is a new approach developed in recent years. There were many differences in opinion with regard to these two approaches in terms of operative time and postoperative pain. It is well known that the immune function is lower in patients with malignant tumor and major thoracic surgery is associated with immunological depression. The research focused on the impact of immune function in the patients with lung cancer underwent these two kinds of approach as to which is lesser. Methods： 50 patients with lung cancer were enrolled into the study, twenty-five patients was accepted Muscle- Sparing thoracotomy and other patients were treated with posterolateral thoracotomy. Cellular immune function, humor immune function, and erythrocytes immune function were evaluated. Results： Demographic analyses demonstrated no difference between the groups in characteristcs. There were no significant difference in cellular, humoral and erythrocytes immune function before the operation. On the first postoperative day, the number of NK cell in MST was 19±7 versus 13±9 in PT, CD4 T cell in MST was 29±9 versus 23±9 in PT, RBC C3bRR was 6.7±2.3 in MST versus 4.8±2.3 in PT, median RBC ICR was 5.4±2.9 versus 13.6±2.8 in PT;on the third day of postoperative, the number of CD4 T cell in MST was 35±9 versus 29±10 in PT, IgG in MST was 10±3 versus 8.8±2.2 in PT, IgA in MST was 2. 1±1. 1 versus 1.6±0.9 in PT, RBC C3bRR in MST was 8.2±2.6 versus 6A3 in PT; on the seventh day of postonerative, the number of IgG in MST was 11±3 versus 9.4±2.3 in PT. The differences of all above data were statistically significant between the two groups. Conclusion： Muscle-Sparing thoracotomy is better than posterolateral thoracotomy for the treatment of lung cancer in terms of immune function damage.