腔镜辅助小切口与完全腔镜甲状腺切除术对患者免疫功能及生活质量的影响

Effect of endoscope assisted small incision and totally endoscopic thyroidectomy on immune function and quality of life

目的探讨腔镜辅助小切口与完全腔镜甲状腺切除术对患者免疫功能及生活质量的影响。方法选择2015年7月至2016年6月在我院行手术治疗的甲状腺疾病患者120例为研究对象,按照随机数表法将其分为A组、B组和C组各40例,分别接受腔镜辅助小切口、完全腔镜甲状腺切除术及传统手术治疗,比较三组患者术前术后T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)及生活质量(GLQI评分)的变化。结果术后1 d,三组患者血清CD3^+、CD4^+、CD4^+/CD8^+均较术前明显降低,且A组、B组高于C组,A组高于B组,差异均有统计学意义(P<0.05);术后3 d,C组患者血清CD3^+、CD4^+、CD4^+/CD8^+仍较术前明显降低,且低于A组、B组,差异均有统计学意义(P<0.05);三组患者的GLQI评分均较术前明显提高,且A组、B组高于C组,A组高于B组,差异均有统计学意义(P<0.05)。结论腔镜辅助小切口、完全腔镜甲状腺切除术与传统甲状腺手术比较,其对机体的免疫功能影响较小,且可以更加显著地改善患者的生活质量,但是腔镜辅助小切口甲状腺切除术上述作用更加明显。

Objective To investigate the effect of endoscope assisted small incision and totally endoscopic thyroidectomy on immune function and quality of life. Methods A total of 120 cases of patients with thyroid diseases who treated in our hospital from July 2015 to June 2016 were selected as the research objects. According to the random number table, the patients were randomly divided into group A, group B and group C, with 40 cases in each group. They were respectively treated with endoscope assisted small incision, totally endoscopic thyroidectomy and traditional surgical. The changes of T lymphocyte subsets（CD3~＋, CD4~＋, CD8~＋, CD4~＋/CD8~＋） and quality of life（GLQI score） were compared among the three groups before and after operation. Results One day after operation, serum CD3~＋, CD4~＋, CD4~＋/CD8~＋in the three groups were all significantly decreased compared with before operation, and the levels were significantly higher in group A, group B than in group C, and also in group A than group B（P〈0.05）. Three days after operation, the serum CD3~＋, CD4~＋, CD4~＋/CD8~＋in group C were significantly decreased compared with before operation, which was lower than that in group A, group B, with statistically significant difference（P〈0.05）. GLQI score in three groups were significantly increased compared with before operation, and the scores were significantly higher in group A, group B than in group C, and also in group A than group B（P〈0.05）. Conclusion Endoscope assisted small incision, totally endoscopic thyroidectomy, compared with traditional thyroidectomy, have smaller impact on the body＇s immune function, and can significantly improve the quality of life, but the endoscope assisted small incision for thyroidectomy is more effective.