全腔镜和腔镜辅助小切口甲状腺手术对机体免疫功能的影响

Impact of Thyroid Surgery with Total Endoscopic Thyroidectomy and Minimally Invasive Video-assisted Thyroidectomy on Immune Function

目的研究全腔镜和腔镜辅助小切口甲状腺手术对机体免疫功能的影响。方法选择2013年1月~2015年1月间笔者医院行甲状腺切除手术的患者共100例,随机分为全腔镜组和腔镜辅助组各50例,观察两组患者手术时间、术中出血量、住院时间、手术费用等手术情况,并且测定两组术前、术后24h外周血淋巴细胞亚群(CD3^+、CD4^+、CD8^+)和免疫球蛋白(IgA、IgG、IgM)水平。结果全腔镜组手术时间长于腔镜辅助组,术中出血量多于腔镜辅助组,住院天数短于腔镜辅助组,医疗费用多于腔镜辅助组,差异均有统计学意义(P<0.01);两组患者手术前淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+∕CD8^+)和免疫球蛋白(IgA、IgG、IgM)水平差异均无统计学意义(P>0.05),术后24h,各CD3^+、CD4^+、CD8^+和IgA、IgG、IgM明显下降,CD4^+/CD8^+比值明显升高,与术前相比差异有统计学意义(P<0.05),两组术后水平比较差异无统计学意义(P>0.05)。结论全腔镜和腔镜辅助小切口均可抑制患者的免疫功能,但两种手术方式对机体免疫功能影响不明显。

Objective To compare the impact of endoscopic thyroidectomy and minimally invasive video-assisted thyroidectomy on immune function of the patients.Methods One hundred cases hospitalized in the period from January 2013 to January 2015 to receive thyroidectomy were divided into 2 groups,each 50 cases in endoscope group and endoscope-assisted group comparison in operation time,the total drainage volume,Intraoperative blood loss,hospitalization duration and expenses was made between the 2 groups.Other surgical situation and lymphocyte subsets （CD3 ＋,CD4 ＋,CD8 ＋）and immunoglobulin （IgA,IgG,IgM） preoperative and postoperative 24h between the two groups were determined.Results The operation time in endoscope group was longer than that in endoscope-assisted group and the Intraoperative blood loss volume were bigger than those in endoscope-assisted group.The hospitalization duration and expenses in endoscope group were shorter than those in endoscope-assisted group（P ＜0.01）.CD3 ＋,CD4 ＋,CD8 ＋,CD4 ＋/CD8 ＋,IgA,IgG,IgM levels before surgery in patients between two groups had no statistically significant differences （P ＞ 0.05）.After 24h,the CD3 ＋,CD4 ＋,CD8 ＋ and IgA,IgG,IgM decreased,CD4 ＋/CD8 ＋ ratio was significantly increased,and the difference was statistically significant （P ＜0.05）.Postoperative levels between two groups were not statistically significant （P ＞ 0.05）.Conclusion Both total endoscopic thyroidectomy and minimally invasive video-assisted thyroidectomy inhabit the immune function of the patients.Thyroid surgery with the two approaches is of no significant difference in the impact on immune function.