胸腔镜治疗原发性纵隔肿瘤及对T淋巴细胞因子的影响

Thoracoscopic treatment of primary mediastinal tumors and its effect on T lymphocyte factors

目的研究电视胸腔镜手术(videoassisted thoracoscopic surgery,VATS)治疗原发性纵隔肿瘤(primary mediastinal tumor,PMT)及其对T淋巴细胞因子的影响。方法选择90例PMT患者按照手术方式分为VATS组(n=45)与开胸组(n=45)。VATS组行VATS治疗,开胸组行开胸切除术。观察指标为:术中失血量、手术时间、镇痛药物使用时间、引流时间及住院时间等手术指标,术前与术后7 d血清白介素-6(interleukin-6,IL-6)、IL-1β、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和C反应蛋白(C-reactive protein,CRP)等炎性因子,术前与术后7 d血清CD3^+、CD4^+、CD8^+和CD4^+/CD8^+等T淋巴细胞因子,术后并发症等。结果VATS组术中出血量、手术时间、镇痛药物使用时间、引流时间及住院时间等均小于开胸组,差异均具有统计学意义(均P<0.05)。术后3 d,VATS组IL-6、IL-1β、TNF-α和CRP水平均低于开胸组,组间差异均具有统计学意义(均P<0.05)。术后7 d,VATS组CD3^+、CD4^+和CD4^+/CD8^+高于开胸组,CD8^+低于开胸组,差异均具有统计学意义(均P<0.05)。VATS组术后并发症发病率(4.4%)低于开胸组(20.0%),差异具有统计学意义(P<0.05)。结论VATS治疗PMT可有效切除病灶,有利于免疫机制恢复,炎性反应小,术后并发症发生率低。

Objective To study the video-assisted thoracoscopic surgery(VATS)for primary mediastinal tumor(PMT)and its influence on T lymphocyte factors.Methods A total of 90 patients with PMT were selected and divided into VATS group(n=45)and thoracotomy group(n=45)according to the treatment.Surgical indicators,such as intraoperative blood loss,duration of surgery,time of using analgesics,drainage time and length of stay in hospital,inflammatory factors,such as serum interleukin-6(IL-6),IL-1β,tumor necrosis factorα(TNF-α)and C-reactive protein(CRP),T lymphocyte factors,such as CD3^+,CD4^+,CD8^+and CD4^+/CD8^+,and postoperative complications in the two groups were observed.Results The intraoperative blood loss,duration of surgery,time of using analgesics,drainage time and length of stay of VATS group were shorter than those of thoracotomy group(all P<0.05).Levels of IL-6,IL-1β,TNF-αand CRP were lower in VATS group than those in thoracotomy group at 3d after surgery(all P<0.05).CD3^+,CD4^+and CD4^+/CD8^+were higher while CD8^+was lower in VATS group than those in thoracotomy group at 7d after surgery(all P<0.05).The incidence rate of postoperative complications in VATS group was lower than that in thoracotomy group(4.4%vs 20.0%,P<0.05).Conclusion VATS can effectively remove the lesions and is conductive to the immune system restoration of PMT patients.It has characteristics of mild inflammatory reactions and low incidence of postoperative complications.