全胸腔镜与后外侧开胸对肺癌患者免疫功能影响的对比研究

Immune Functions of Patients Following Lobectomy for Lung Cancers: a Comparative Study Between Video-assisted Thoracoscopic Surgery and Posterolateral Thoracotomy

目的比较全胸腔镜与后外侧开胸手术对非小细胞肺癌患者的早期创伤指标及免疫功能的影响。方法前瞻性连续收集2008年7月至2009年7月间于我科接受后外侧开胸(PLT组)或胸腔镜(VATS组)手术治疗的确诊或拟诊的临床早期非小细胞肺癌患者的临床资料,并采集血液标本。检查所有患者术前、术后24h、术后72h外周血血清中C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、白细胞介素6(IL-6)及白细胞介素2受体(IL-2R)的浓度。检测术前、术后3d及术后7d外周血淋巴细胞(L)计数及淋巴细胞中CD4+T淋巴细胞、CD8+T淋巴细胞、自然杀伤细胞(NK)比例。对两组患者上述指标进行比较。结果共纳入103例非小细胞肺癌患者,其中VATS组51例,PLT组52例。VATS组患者术中失血量少于PLT组(P=0.001)。PLT组患者术后12h时SAA浓度高于VATS组(P=0.006)。PLT组患者术后CD8+T比例较术前降低,差异有统计学意义(P<0.001),但VATS组患者术后CD8+T比例较术前减低幅度小,差异无统计学意义(P>0.05)。PLT组患者术后7d时CD8+T比例低于VATS组(P=0.015)。结论与常规后外侧开胸手术相比较,单向式胸腔镜肺癌切除术可以降低患者术后急性期反应,减轻对患者免疫功能的抑制。

Objective To compare acute inflammatory responses and immunosuppression to lobectomy in lung cancer patients with video-assisted thoracoscopic surgery （VATS） and posterolateral thoracotomy （PLT）. Methods A total of 103 patients who underwent either a VATS （n= 51） or a PLT （n= 52） lobectomy for early non-small cell lung cancers （NSCLC, stage I ） were recruited for this study. Blood samples of the participants were taken pre- operatively and at 24 h and 72 h post-operatively for analyses of C-reactive protein （CRP）, interleukin （IL）-6, IL-2 receptors （IL-2R）, and serum amyloid A （SAA）. Blood samples taken pre-operatively and at 2 d and 7 d post operations were also analyzed for total lymphocytes, NK cells, CD4＋ T, and CD8＋ T. Results Patients in the VATS group lost significantly less blood than those in the PLT group （P=0. 001）. Patients in the PLT group had significantly higher serum SAA than those in the VATS group （P= 0. 006）. Significant reduction of CD8＋T was found in the patients with PLT after operations （P〈0.01）. Patients in the PLT group had significantly lower at CD8＋T 7 d post operations than those in the VATS group （P=0. 015）. Conclusion VATS pulmonary lobectomy is associated with reduced acute inflammatory responses and immunosuppression compared with the PLT approach.