机器人与胸腔镜肺叶切除对非小细胞肺癌患者机体创伤及淋巴细胞亚群的影响

The effects of robotic versus thoracoscopic lobectomy on body trauma and lymphocyte subsets in patients with non-small cell lung cancer

目的探讨机器人与胸腔镜肺叶切除对非小细胞肺癌患者机体创伤及淋巴细胞亚群的影响。方法收集本中心同时期同一手术组进行肺叶切除120例非小细胞肺癌患者的临床资料。根据手术方式不同,将患者分为机器人组(n=60)和胸腔镜组(n=60)。记录两组患者手术时间、术中出血量、术后引流时间、引流量、术后住院时间、并发症发生率、疼痛视觉模拟评分(visual analogue scale,VAS)等围手术期指标,分别于术前、术后1 d、3 d测定炎性标志物:C-反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6),淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))的水平。比较两种手术方式对患者机体创伤及淋巴细胞亚群的影响。结果机器人组手术时间、术中出血量、术后引流时间、引流量、VAS均低于胸腔镜组,差异有统计学意义(P<0.05)。胸腔镜组术后第1 d IL-6高于机器人组,CD3^(+)、CD4^(+)、CD8^(+)低于机器人组,差异有统计学意义(P<0.05)。结论与胸腔镜肺叶切除相比,机器人肺叶切除手术创伤小、诱发机体炎症反应轻、恢复快、对淋巴细胞亚群的抑制作用更轻,具有临床优越性。

Objective To investigate the effects of robotic versus thoracoscopic lobectomy on body trauma and lymphocyte subsets in patients with non-small cell lung cancer(NSCLC).Methods The clinical data of 120 patients with NSCLC who underwent lobectomy in the same operation group at the same period were collected and divided into a robot group(n=60)and a thoracoscope group(n=60)according to different surgical methods.The operation time,intraoperative blood loss,postoperative drainage time,drainage volume,postoperative hospital stay,complication rate,pain visual analogue scale(VAS)and other perioperative indicators were recorded in the two groups.Inflammatory markers:C-reactive protein(CRP),interleukin-6(IL-6)and lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))levels were measured before and 1 d,3 d after surgery.The effects of the two surgical methods on the body trauma and lymphocyte subsets were compared.Results The operation time,intraoperative blood loss,postoperative drainage time,drainage volume and VAS of the robot group were lower than those of the thoracoscope group,and the differences were statistically significant(P<0.05).On the 1 st day after surgery,IL-6 of the thoracoscope group was higher than that of the robot group,while CD3^(+),CD4^(+)and CD8^(+)were lower than those of the robot group,with statistically significant differences(P<0.05).Conclusion Compared with thoracoscopic lobectomy,robotic lobectomy has less trauma,less inflammatory response,faster recovery,less inhibitory effect on lymphocyte subsets,and has clinical advantages.