开胸与胸腔镜手术影响肺癌患者术后调节T细胞功能和T淋巴细胞亚群的临床研究

Comparitive study on the effects of thoracotomy and thoracoscopic surgery on T cell function and T lymphocyte subsets in patients with lung cancer after surgery

目的比较开胸与胸腔镜手术治疗肺癌患者术后调节T细胞功能和T淋巴细胞亚群的影响。方法选取2014年6月至2017年10月治疗的Ⅰ期肺癌病例共140例为研究对象,随机分为开胸组(TS组)和胸腔镜组(AS组),每组70例。2组患者分别在手术前及手术后第1、3和6天检测T细胞亚群CD^+3、CD^+4、CD^+8、CD^+4/CD^+8比值以及血清中MDA、SOD的值,并进行相关性分析。结果AS组患者和TS组患者在手术后的第1天血清中的SOD值差异无统计学意义(P>0.05),手术后第3天和第6天AS组较TS组差异有统计学意义(P<0.05),且与各自的第1天比较明显增高,差异有统计学意义(P<0.05)。AS组患者和TS组患者在手术后第1天血清中MDA值差异无统计学意义(P>0.05),手术后第3天和第6天AS组较TS组差异有统计学意义(P<0.05),AS组术后第3天和第6天与其术后第1天比较MDA值明显增高(P<0.05)。TS组患者术后第3天血清MDA值与术前第1天比较略有上升,但差异无统计学意义(P>0.05);术后第6天血清MDA值与术前第1天比较上升,差异有统计学意义(P<0.05)。AS组和TS组术后第3天和第6天CD^+3、CD^+4、CD^+8、CD^+4/CD^+8比值与第1天比较上升明显(P<0.05),且AS组与TS组差异有统计学意义(P<0.05)。结论比较胸腔镜手术治疗肺癌患者较开胸术对机体免疫系统影响小,且术后免疫功能恢复好。

Objective To compare the effects of thoracotomy and thoracoscopic surgery on T cell function and T lymphocyte subsets in patients with lung cancer after surgery.Methods A total of 140 patients with stage I lung cancer who were treated in our hospital from June 2014 to October 2017 were enrolled in the study,who were were randomly divided into the thoracotomy group(TS group)and thoracoscopic surgery group(AS group),with 70 patients in each group.The levels of CD^+3,CD^+4,CD^+8,CD^+4/CD^+8 and serum levels of MDA and SOD were detected before surgery and at 1d,3d,6d after surgery,and the correlation analysis was performed.Results There were no significant differences in serum levels of SOD at 1d after surgery between AS group and TS group(P>0.05),however,the serum levels of SOD at 3d,6d after surgery in both groups were significantly increased,moreover,there were significant differences in serum levels of SOD at 3d,6d after surgery between AS group and TS group(P<0.05).There were no significant differences in serum levels of MDA at 1d after surgery between AS group and TS group(P>0.05),however,there were significant differences in serum levels of MDA at 3d,6d after surgery between AS group and TS group(P<0.05).As compared with those at 1d after surgery,the serum levels of MDA at 3d,6d after surgery in AS group were significantly increased(P<0.05).Moreover there were no significant differences in serum levels of MDA in TS group between those at 3d after surgery and those at 1d after surgery(P>0.05),however,there were significant differences in serum levels of MDA in TS group between those at 6d after surgery and those at 1d after surgery(P<0.05).As compared with those at 1d after surgery,the serum levels of CD^+3,CD^+4,CD^+8,CD^+4/CD^+8 at 3d,6d after surgery were significantly increased in both groups(P<0.05),moreover,there were significant differences between AS and TS group(P<0.05).Conclusion The thoracoscopic surgery has less effects on the immune function of patients with lung cancer after surgery than those by thoracotomy,with better recovery of immune function.