甲状腺腔镜术式与常规术式对人体细胞免疫影响的实验研究

Endoscopic thyroidectomy versus conventional surgery:different influence to cellular immunity

目的:比较经胸前径路腔镜甲状腺手术与常规手术对机体细胞免疫功能的影响,以期对腔镜治疗甲状腺恶性肿瘤的可行性提供理论依据。方法:选择2007年7月至12月我科治疗的40例甲状腺结节患者,20例行经胸前径路腔镜甲状腺手术(ET组),20例行常规手术(CT组),两组分别于术前及术后第1、3、5天抽血,并用流式细胞仪测定自然杀伤细胞(NK细胞)数量;CD3+、CD4+、CD8+T淋巴细胞百分比及CD4+/CD8+比值。结果:ET组和CT组NK细胞术后第1天均升高,与术前相比有显著差异(P<0.05),术后第3天ET组NK细胞明显减少,术后第5天开始恢复,均与术前有显著差异(P<0.05);CT组术后第3天也出现下降趋势,至术后第5天下降更明显,与术前有显著差异(P<0.05)。ET组和CT组的CD3+、CD4+T淋巴细胞、CD4+/CD8+比值术后第1天均下降,与术前有显著差异(P<0.05),其中CT组的CD3+、CD4+T淋巴细胞百分比下降更为明显,与ET组相比差异有统计学意义(P<0.05)。ET组CD3+T淋巴细胞百分比在术后第3天恢复至正常水平,而CT组仍显著降低,与术前及与ET组相比均有显著差异(P<0.05)。结论:经胸前径路腔镜甲状腺手术与常规手术均在术后早期抑制了机体的细胞免疫功能,但与常规手术相比,腔镜手术后恢复至正常水平的时间更快,说明其引起的创伤应激导致的免疫抑制作用较小。

Objective：To evaluate the different influence to cellular immunity after thyroidectomy by endoscopic and conventional approaches.Methods：From Jul.2007 to Dec.2007,40 patients underwent thyroidectomy were divided into two groups nonrandomly.20 patients with endoscopic approach（ET group）,and another 20 patients with conventional approach（CT group）.Blood samples were taken before operation and on postoperative day 1,3 and 5.Using flow cytometry,natural killer cells（NK cells） were calculated and CD3^＋、CD4^＋、CD^8＋ T-lymphocytes,CD4＋/CD8＋ ratios were measured.Results：NK cells increased in both groups on the postoperative day 1.In ET group,it decreased on postoperative day 3 and day 5,but the index of day 5 was higher than that of day 3.In CT group,it also had descendent trend on postoperative day 3,and decreased obviously on day 5.CD3^＋、CD4^＋T-lymphocytes and CD4＋/CD8＋ ratios decreased in both two groups on postoperative day 1.Compared with ET group,CD3^＋、CD4^＋T-lymphocytes decreased more obviously in CT group,there was significant difference（P〈0.05）.On postoperative day 3,CD3^＋remained low in CT group but restored normally in ET group（P〈0.05）.Conclusions：Cellular immunity of patients is both impaired in earlier period of endoscopic thyroidectomy by breast approach and conventional approach,but it restored earlier in patients undergoing endoscopic approach.It suggests that endoscopic thyroidectomy by breast approach is associated with less impairment of cellular immunity.