胸腔镜肺叶切除术对非小细胞肺癌患者免疫功能及炎症反应的影响

Effects of thoracoscopic lobectomy on immune function and inflammatory response in patients with non-small cell lung cancer

目的探讨胸腔镜肺叶切除术对非小细胞肺癌(NSCLC)患者免疫功能及炎症反应水平的影响。方法选取成武县人民医院2019年1月至2020年12月收治的98例NSCLC患者作为研究对象,根据手术方式不同分为对照组与研究组,其中对照组(采用常规开胸手术治疗,49例)、研究组(采用胸腔镜肺叶切除术治疗,49例)。2组患者均观察至出院并随访3个月。比较2组患者术中及术后3 d的临床指标,术前及术后3 d的免疫功能及血清降钙素原(PCT)、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)水平情况、术前及术后3个月的生活质量评分。结果研究组患者手术时间、切口长度短于对照组,术中出血量、术后当日引流量低于对照组(P<0.05),而2组患者术中淋巴结清扫数目比较,差异无统计学意义(P>0.05)。术前,2组血浆CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平相比,差异无统计学意义(P>0.05);术后3 d研究组血浆CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平均高于对照组(P<0.05);术前,2组血清PCT、IL-8、IL-6水平相比,差异无统计学意义(P>0.05);术后3 d研究组血清PCT、IL-8、IL-6水平低于对照组(P<0.05);术前,2组躯体、角色、情绪、认知、社会功能评分相比,差异无统计学意义(P>0.05);术后3个月研究组躯体、角色、情绪、认知、社会功能评分均高于对照组(P<0.05)。结论胸腔镜肺叶切除术对NSCLC患者可有效缓解临床症状,优化手术指标,减小手术对免疫功能、炎症反应的影响,提高生活质量,提高临床疗效。

Objective To investigate the effects of thoracoscopic lobectomy on immune function and serum levels of procalcitonin(PCT),interleukin(IL)-8 and IL-6 in patients with non-small-cell lung cancer(NSCLC).Methods Ninety-eight patients with NSCLC in Chengdu People′s Hospital from January 2019 to December 2020 were selected as the research object and were divided into the control group and the study group according to different surgical methods,including the control group(49 patients receiving conventional thoracotomy)and the study group(49 patients receiving thoracoscopic lobectomy).Both groups were observed until discharge and followed up for 3 months.Clinical indexes,immune function and serum PCT,IL-8 and IL-6 levels before and 3 days after surgery,and life quality scores before and 3 months after surgery were observed and compared between the two groups.Results The operation time and incision length of the study group were shorter than those in the control group,and the intraoperative blood loss and postoperative drainage on the same day were lower than those of the control group(P<0.05).There was no statistical significance in the number of intraoperative lymph node dissection between the two groups(P>0.05).Before the operation,there was no significant difference in the levels of CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)between the two groups(P>0.05).The plasma levels of CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)of the study group were higher than those of the control group 3 days after the operation(P<0.05).Before the operation,there was no significant difference in the levels of serum PCT,IL-8 and IL-6 between the two groups(P>0.05).The levels of serum PCT,IL-8 and IL-6 of the study group were lower than those of the control group 3 days after operation(P<0.05).Before the operation,there was no significant difference in the scores of body,role,emotion,cognition and social function between the two groups(P>0.05).The scores of body,role,emotion,cognition and social function of the study group were higher than those of the control group 3 months after operation(P<0.05).Conclusion Thoracoscopic lobectomy can effectively relieve clinical symptoms in patients with NSCLC,optimize surgical indicators,reduce the impact of surgery on immune function and inflammatory response,and improve quality of life and clinical efficacy.