【摘要】 目的探讨胸腔镜辅助与传统根治术对食管癌患者围手术期免疫功能的影响。方法收集2009年1月~2012年12月该科收治的食管癌患者中入组的患者75例,将其根据手术方式不同分组:35例接受胸腔镜辅助手术(VATS组),30例接受传统开胸食管癌根治术(传统组)。两组患者均于术前1 d、术毕、术后1、3及7 d时抽取空腹静脉血2 mL,采用ELISA方法测定免疫球蛋白IgA、IgM及IgG,采用流式细胞仪检测患者外周血T细胞亚群(CD3+、CD4+、CD8+)以及NK细胞含量。结果①术毕、术后1~3 d,传统组IgA、IgM及IgG水平呈逐渐下降趋势,均较术前显著降低(P<0.05),术后7 d时略升高,但仍明显低于术前水平(P<0.05)。术毕、术后1 d,VATS组IgA、IgM及IgG水平较术前显著降低(P<0.05),术后3 d时开始升高,7 d时与术前比较差异无显著性(P>0.05)。两组各检测指标之间比较,术后3~7 d,VATS组IgA、IgM及IgG水平均显著高于传统组(P<0.05)。②术毕、术后1、3 d时,传统组患者的CD3+、CD4+及CD4+/CD8+比值及NK细胞含量均较术前明显下降,术后7 d时CD3+、CD4+及CD4+/CD8+比值及NK细胞含量有所升高,但仍明显低于术前水平。术毕、术后1 d时,VATS组患者的CD3+、CD4+及CD4+/CD8+比值及NK细胞含量也均较术前明显下降,之后逐渐升高,术后7 d时已基本恢复术前水平(P>0.05)。两组各检测指标之间比较,术后1~7 d,VATS组患者CD3+、CD4+及CD4+/CD8+比值及NK细胞含量均明显高于传统组(P<0.05)。结论胸腔镜辅助食管癌根治术对食管癌患者术后免疫功能的影响小,有利于患者的术后恢复,明显优于传统开胸手术。更多还原

【Abstract】 【Objective】To evaluate the influence of video-assisted thoracoscopic surgery(VATS) and routine operation on immunity index of esophageal cancer patients.【Methods】75 esophageal cancer patients were classified into VATS group(n=35) and routine operation group(n=30) randomly.The blood sample was taken from two groups at the following time: day one before operation,immediately after operation,the first postoperative day,the third postoperative day,the seventh postoperative day.The level of IgA,IgM,IgG was measured by ELISA.The content of T-lymphocyte subgroups(CD3 +,CD4 +,CD8 +) and NK cells were measured by flow cytometry.【Results】①At immediately after operation,the first to the third postoperative day,the level of IgA,IgM,IgG in routine operation group kept on decreasing significantly compared with before treatment(P <0.05).At the seventh postoperative day,the level of IgA,IgM,IgG in routine operation group began increasing,but were lower than those of before treatment(P <0.05).At immediately after operation,the first postoperative day,the level of IgA,IgM,IgG in VATS group kept on decreasing significantly compared with before treatment(P <0.05).At the third postoperative day,the level of IgA,IgM,IgG in VATS group began increasing,and at the seventh postoperative day there were no significantly different compared with before treatment(P >0.05).At the third to the seventh postoperative day,the level of IgA,IgM,IgG in VATS group were higher than those of routine operation group(P <0.05).②At immediately after operation,the first to the third postoperative day,the content of CD3 +,CD4 +,CD4 +/CD8 +and NK in routine operation group decreased significantly compared with before treatment(P <0.05).At the seventh postoperative day,the content of CD3 +,CD4 +,CD4 +/CD8 +and NK in routine operation group began increasing,but were lower than those of before treatment(P < 0.05).At immediately after operation,the first postoperative day,the content of CD3 +,CD4 +,CD4 +/CD8 +and NK in VATS group decreased significantly compared with before treatment(P <0.05).At the third postoperative day,the content of CD3 +,CD4 +,CD4 +/CD8 +and NK in VATS group began increasing,and at the seventh postoperative day there were no significantly different compared with before treatment(P >0.05).At the first to the seventh postoperative day,the content of CD3 +,CD4 +,CD4 +/CD8 +and NK in VATS group were higher than those of routine operation group(P < 0.05).【Conclusion】VATS is of little effect on immunity index postoperative of esophageal cancer patients,and is better for postoperative recovery of patients compared with routine operation.更多还原