胸导管阻断对食管癌切除患者细胞免疫的影响

Effects of thoracic duct ligation on cellular immunity of patients with esophageal carcinoma

目的 探讨食管癌手术中预防性结扎胸导管对患者细胞免疫功能的影响。方法 将 10 8例0～Ⅲ期食管癌患者随机分为胸导管结扎组 (74例 )和未结扎组 (34例 ) ,术前及术后不同时间用碱性磷酸酶抗碱性磷酸酶 (APAAP)法动态监测外周血T淋巴细胞、T淋巴细胞亚群及CD16+56+细胞 ,并与 2 0例健康献血员进行对比。结果 食管癌患者术前CD3+、CD4 +T淋巴细胞、CD4 +/CD8+及CD16+56+细胞均明显低于正常对照组 (P <0 .0 0 1) ,术后前 3dCD3+、CD4 +、CD8+T淋巴细胞及CD16+56+细胞均降低明显(P <0 .0 5 ) ;上述各项指标术后第 5d开始恢复 ,以后各期除CD8+T淋巴细胞外 ,与术前相比均无显著差异 (P >0 .0 5 )。胸导管结扎组与未结扎组相比 ,术后各期各项指标均无显著差异 (P >0 .0 5 )。结论 食管癌患者术前细胞免疫功能低下 ,术后降低更为显著 ,但可逐渐恢复。手术切除肿瘤组织后 ,免疫功能紊乱得到纠正。胸导管结扎对食管癌患者细胞免疫近期无明显影响。

Objective To explore the effects of preventive thoracic duct ligation on the cellular immunity in patients with esophageal carcinoma. Methods One hundred and eight cases of esophageal carcinoma with stage 0-III were randomly divided into two groups, 74 cases with thoracic duct ligation and 34 cases without thoracic duct ligation. The levels of T lymphocytes, T lymphocyte subsets and CD 16+56 + cells in peripheral blood were measured with alkaline phosphatase anti-alkaline phosphatase (APAAP) method in both groups before resection and after resection at 1d postoperative day (1st d), 3rd d, 5th d, 1st week(1st wk), 2nd wk, and 3rd wk, and 20 normal blood donors were as controls. Results The preoperative levels of CD 3 +, CD 4 + T lymphocytes and the ratio of CD 3 +/ CD 4 + and CD 16+56 + cells in patients were lower than that in the control group (P<0.001). Compared with preoperation, the postoperative levels of CD 3 +, CD 4 + CD 8 + T lymphocytes and CD 16+56 + cells decreased significantly in first three days (P<0.05), and began to restore at 5th d. There was no significant difference in the levels of CD 3 +, CD 4 + CD 8 + T lymphocytes and CD 16+56 + cells between two groups (P>0.05). Conclusion The patients with esophageal carcinoma have a lower cellular immunity function before operation and may further decrease after operation, but can restore gradually. The cellular immunity function of the patients with esophageal carcinoma undergone resection can be regulated. The thoracic duct ligation does not influence the short-term cellular immunity function of the patients.