全胸腔镜与常规开胸手术对非小细胞肺癌患者免疫功能影响的比较

A Comparative Study Between Video-assisted Thoracoscopic Surgery and Conventional Thoracotomy on Immune Functions For Non-Small Cell Lung Cancer Patients

目的比较全胸腔镜与常规开胸手术对非小细胞肺癌患者免疫功能的影响。方法收集2012年5月至2014年5月间于我科接受常规开胸(PLT组)或全胸腔镜(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;检测术前、术后1 d、3 d及7 d外周血免疫球蛋白Ig G、Ig A、Ig M以及CD3+T、CD4+T、CD8+T含量,并计算CD4+/CD8+T比值,对两组患者上述指标进行比较。结果两组术后1 d血清Ig G均有下降(P<0.01),但开胸组较全胸腔镜组下降更明显(P<0.05);两组术后CD3+T、CD4+T含量均低于术前水平(P<0.05);组间比较,术后1 d PLT组CD3+T、CD4+T、CD8+T均明显低于VATS组(P<0.05)。结论与常规开胸手术比较,胸腔镜手术可以减轻患者免疫功能的抑制,在早期肺癌根治术中具有明显优势。

Objective To compare immunosuppression to lobectomy in lung cancer patients with video-assisted thoracoscopic surgery（ VATS） and conventional thoracotomy.Methods A total of 162 patients who underwent either a VATS or a CLT lobectomy for early non-small cell lung cancers in our hospital from May 2012 to May 2014 were recruited.Blood samples of the patients were taken pre-operatively and at 1d,3 d and 7d postoperations for analyses of CD3＋T,CD4＋T,CD8＋T,CD4＋/ CD8＋T and Ig G,Ig A,Ig M.Results There was no significant difference for all the indicators between the two groups. The Ig G levels decreased markedly at 1 d postoperatively in both groups,but much lower in CLT patients. CD3＋T,CD4＋T after operation of the two groups were significantly lower than those before operation.Patients in the CLT group had significantly lower at CD3＋T,CD4＋T,CD8＋T 1 d post operation than those in the VATS group with statistical significance. Conclusion VATS pulmonary lobectomy is associated with reduced immunosuppression compared with the CLT approach,and has great advantages of therapy for early non-small cell lung cancers.