胸腔镜肺叶切除术对老年非小细胞肺癌患者术后早期创伤指标和炎性因子及免疫应答的影响

Effect of thoracoscopic pulmonary lobectomy on early postoperative trauma indexes,inflammatory factors and immune response in elderly patients with non-small cell lung cancer

目的研究胸腔镜肺叶切除术对老年非小细胞肺癌患者术后早期创伤指标和炎症因子及免疫应答的影响。方法选取2015年7月至2017年7月在新疆维吾尔自治区人民医院进行手术治疗的78例老年非小细胞肺癌患者,根据手术方式不同分为对照组(38例)和观察组(40例)。对照组采用传统的开胸切除术进行治疗,观察组采用胸腔镜肺叶切除术进行治疗。记录2组患者的切口长度、手术时间、术中出血量、淋巴结清扫数量、术后疼痛分级、术后72 h内胸腔引流管的引流时间及引流量、下床活动时间、住院时间、术后并发症情况;检测手术前后白细胞介素6(IL-6)<IL-8、IL-10、C反应蛋白(CRP)与肿瘤坏死因子α(TNF-α)水平的变化,并检测手术前后非特异性免疫反应指标补体C_3、C_4水平,以及特异性免疫反应指标外周血T淋巴细胞亚群CD_4^+、CD_8^+、CD_4^+/CD_8^+水平及免疫球蛋白G(IgG)、IgA与IgM水平变化。结果 2组患者术后均未出现并发症。观察组患者手术切口长度、手术时间、术中出血量、72 h内引流时间、下床活动时间、住院时间均短于(少于)对照组,差异均有统计学意义(均P<0.05)。术前2组患者早期创伤、炎症因子及免疫应答相关指标差异均无统计学意义(均P>0.05);术后2组患者IL-6、IL-8、IL-10、CRP及TNF-α水平均明显高于术前,但观察组低于对照组[(28±6)ng/L比(31±5)ng/L、(45.9±3.9)ng/L比(47.9±4.0)ng/L、(53.2±5.8)ng/L比(57.9±6.9)ng/L、(44.2±5.1)mg/L比(49.7±4.1)mg/L、(382±31)ng/L比(411±32)ng/L],差异均有统计学意义(均P<0.05);术后2组患者补体C_3、C_4水平明显低于术前[对照组:(0.41±0.32)g/L比(0.67±0.28)g/L、(0.12±0.07)g/L比(0·17±0.09)g/L;观察组:(0.52±0.18)g/L比(0.65±0.27)g/L、(0.13±0.06)g/L比(0.16±0.08)g/L],但观察组高于对照组,差异均有统计学意义(均P<0.05);术后对照组患者CD_4^+、CD_8^+、CD_4^+/CD_8^+及观察组CD_4^+水平低于术前,但观察组三者均高于对照组,差异均有统计学意义(均P<0.05);术后2组患者IgG、IgA与IgM水平均低于术前,其中IgG下降最明显,但观察组均高于对照组,差异均有统计学意义(均P<0.05)。结论胸腔镜肺叶切除术对老年非小细胞肺癌患者的早期创伤小,可以明显缓解机体炎性反应,提高机体特异性和非特异性免疫应答功能。

Objective To analyze the effect of thoracoscopic pulmonary lobectomy on early postoperative trauma indexes, inflammatory factors and immune response in elderly patients with non-small cell lung cancer. Methods Seventy-eight elderly patients with non-small cell lung cancer were enrolled from July 2015 to July in People′s Hospital of Xinjiang Uygur Autonomous Region. Thirty-eight patients had open lung lobectomy（control group）, and 40 patients had thoracoscopic lung lobectomy（observation group）. Incision length, operation time, intraoperative blood loss, lymph node dissection number, postoperative pain degree, thoracic drainage time, postoperative 72 h thoracic drainage volume, ambulation time, hospitalization time and complications were recorded. Levels of interleukin-6（IL-6）, IL-8, IL-10, C-reactive protein（CRP）, tumor necrosis factor-α（TNF-α）, C3, C4, CD＋4, CD＋8, CD＋4/CD＋8, immunoglobulin G（IgG）, IgA and IgM were detected before and after operation. Results No operation-related complications occurred in both groups. Incision length, operation time, intraoperative blood loss, 72 h drainage volume, ambulation time and hospitalization time in observation group were significantly shorter/less than those in control group（P〈0.05）. Trauma, inflammatory and immune indexes had no significant differences between groups before operation（P〉0.05）. After operation, levels of IL-6, IL-8, IL-10, CRP and TNF-α significantly increased, and these indexes in observation group were significantly lower than those in control group［（28±6）ng/L vs （31±5）ng/L, （45.9±3.9）ng/L vs （47.9±4.0）ng/L, （53.2±5.8）ng/L vs （57.9±6.9）ng/L, （44.2±5.1）mg/L vs （49.7±4.1）mg/L, （382±31）ng/L vs （411±32）ng/L］（P〈0.05）. Levels of C3 and C4 significantly decreased after operation［observation group： （0.41±0.32）g/L vs（0.67±0.28）g/L, （0.12±0.07）g/L vs（0.17±0.09）g/L; control group： （0.52±0.18）g/L vs（0.65±0.27）g/L, （0.13±0.06）g/L vs（0.16±0.08）g/L］; C3 and C4 after operation in observation group were significantly higher than those in control group（P〈0.05）. Levels of CD＋4, CD＋8, CD＋4/CD＋8 in control group and CD＋4/CD＋8 in observation group significantly decreased after operation; CD＋4, CD＋8, CD＋4/CD＋8 in observation group were significantly higher than those in control group（P〈0.05）. Levels of IgG, IgA and IgM significantly decreased after operation; IgG, IgA and IgM in observation group were significantly higher than those in control group（P〈0.05）. Conclusion Thoracoscopic pulmonary lobectomy treating elderly patients with non-small cell lung cancer can reduce early injury, relieve inflammatory reaction, and improve specific and nonspecific immune response.