胸腔镜微创手术与开胸手术比较对胸腺瘤合并重症肌无力患者炎性反应的研究

Comparison of inflammatory reaction for patients with thymomas and myasthenia gravis treated by traditional thoracotomy or minimally invasive surgery

目的探讨胸腔镜微创与开胸两种手术方式对胸腺瘤合并重症肌无力患者炎性反应的影响。方法纳入2014年8月至2015年6月接受手术治疗的MasaokaⅠ期或Ⅱ期的胸腺瘤合并重症肌无力患者,胸腔镜手术治疗组与传统开胸手术治疗组各20例。于麻醉前(T1)、麻醉后(T2)、切皮后2 h(T3)、术后24 h(T4)、术后48 h(T5)和术后72 h(T6)6个时间点取外周静脉血,应用酶联免疫试剂盒(ELISA)检测IL-6、IL-8、TNF-α、CRP、CORT的浓度。记录患者围手术期一般临床资料。采用SPSS 17.0软件对数据进行统计分析。结果胸腔镜组和传统开胸组各相邻时间点炎性因子比较:IL-6、IL-8、TNF-α、CRP和CORT的表达水平在T1、T2和T3三个时间点比较差异无统计学意义(P值均>0.05);术后各因子水平比术前明显升高,T4时间点达到峰值(P值均<0.01),而后逐渐下降。T6时间点除胸腔镜组TNF-α恢复至术前水平(P>0.05)外,胸腔镜组和传统开胸组其它各因子仍高于术前水平(P值均<0.01)。胸腔镜组各因子在T4、T5和T6时间点明显低于传统开胸组(P值均<0.05)。胸腔镜组手术时间、术后引流管留置时间、切口愈合时间明显少于开胸组(P值均<0.05)。结论胸腔镜下胸腺瘤根治术可减少患者手术创伤,减轻炎性反应程度,具有较好的临床推广价值。

Objective To investigate the effects of inflammatory reaction of thymomas with myasthenia gravis （MG） treated by traditional thoracotomy and minimally invasive surgery. Methods A total of 40 thymomas patients （Mssaoka Ⅰ or Ⅱ ） with myasthenia gravis from August 2014 to June 2015 were treated by traditional thoracotomy （n=20） or video-assisted thoracoscopic surgery （n=20）. The serum levels of IL-6, IL-8, TNF-α, CRP and CORT were measured by enzyme-linked immunosorbent assay （ELISA） methods at before anesthesia （T1）, after anesthesia （T2）, 2 h after skin cut （T3）, 24 h post-operation （T4）, 48 h post-operation （TS） and 72 h post-operation （T6） respectively. Perioperative parameters were also reported. The statistics analysis was performed by SPSS 17.0 software. Results The serum levels of IL-6, IL-8, TNF-a, CRP and CORT had no significant difference between T1 and T2, T2 and T3 （all P value〉0.05） in both groups. But the serum levels of these factors after operation were obviously higher than that of before operation, commonly the highest level was reached at T4 （all P value〉0.01）, and also was higher at T6 than that of before the operation （all P value〈0.01）, except the level of TNF-a recovered rapidly to the level of before operation （all P value〉0.05） in the VATS group. The operation time, postoperative drainage tube indwelling time and incision healing time in the VATS were lower than that in the control group （all P value〈0.05）. Conclusion VATS could be widely applied in clinical practice with lowering operative trauma and reducing the degree of inflammatory reaction.