免疫角度比较全胸腔镜与常规开胸在肺癌根治术中的不同

Immune Perspective Comparison of Full Thoracoscopy and Conventional Thoracotomy in Lung Cancer Radical Surgery

目的通过随机对照研究,比较电视辅助胸腔镜手术与传统开胸手术肺切除术治疗肺癌术前及术后细胞因子水平,从而对肿瘤研究提供一些新思路。方法自2009年12月～2012年3月,笔者医院全胸腔镜组40例,开胸组40例,比较两组相关临床指标;并分别于术前1天,术后1、3、5天测定血浆中CD3、CD4、CD8、NK细胞、肿瘤坏死因子(TNF-α)、白介素(IL-2、4、6、10)的浓度并进行比较。结果两组组间术前所有指标无明显差异。全胸腔镜组患者在手术时间、术中出血量、术后引流液量、术后拔管时间、下床活动时间、术后住院时间等方面较开胸组有明显优势。两组组间比较,术后第1天开胸组CD3、CD4、CD8均明显低于全胸腔镜组;而术后第1天IL-6相反。术后两组患者术前后两组患者NK细胞、TNF-α、白介素-2、4的血浆浓度均值不超过4ng/L,差异无统计学意义。结论无论是从术后临床表现的角度还是机体保护的角度来看,全胸腔镜在早期肺癌肺叶切除术中均具有明显的优越性。

Objective To compare the video - assisted thoracoscopic surgery （VATS） lung cancer radical surgery with conventional thoracotomy by detecting the levels of cytokines before and after the operations with randomized study and to provide some new ideas in cancer research. Methods The clinical indicators of 40 patients in thoracotomy group and 40 patients in thoracoscopic group in our hos- pital from December 2009 to March 2012 were evaluated. The blood samples were taken from the patients＇ peripheral vein one day before surgery, 3 and 5 days after the surgery and the concentrations of plasma of lymphocytes CD3, CD4, CD8, NK cells, tumor necrosis factor （TNF- alpha） , white interleukin （IL- 2, 4, 6, 10） were determined and compared. Results There was no significant difference for all the indicators between the two groups. The patients in full thoracoscopic group were better in the operative time, intraoperative blood loss, postoperative drainage, postoperative time to extubation, ambulation time, postoperative hospital stay than thoracotomy group. The CD3, CD4, CD8 and IL - 6 levels of one day before surgery group were significantly lower than full thoracoscopic group,and IL - 6 level was on the contrary. The average concentrations of plasma of NK cell, TNF - α, IL - 2, IL - 4 in the two groups before and after operations were not higher than 4ng/L without statistical significance. Conclusion The full - thoracoscopic surgery was superior than conventional thoracic surgery in postoperative clinical manifestations and body protection point of view.