【摘要】 目的通过研究探讨电视胸腔镜手术(video-assisted thoracic surgery,VATS)与后外侧开胸术(posterolateral thoracotomy,PT)对肺结核患者免疫功能的影响。方法选择新疆维吾尔自治区胸科医院胸外二科2015年1月-2016年12月实施肺叶切除术的肺结核患者84例,采用非随机分组,实施VATS患者为实验组,实施PT患者为对照组。两组患者术前3 d、术后第1 d、第3 d和第7 d分别晨起空腹抽取外周静脉血进行细胞免疫、体液免疫检查。分析两组之间的差异性。结果细胞免疫:VATS与PT组术前细胞免疫比较差异无统计学意义(P>0.05),术后第1 d CD3,第7 d CD3和CD4~+,两组比较差异有统计学意义(P<0.05)。体液免疫:VATS与TP组术前体液免疫比较差异无统计学意义(P>0.05),两组术后第1 d IgA含量比较差异有统计学意义(P<0.05)。营养状态:VATS与TP组术前营养状态比较差异无统计学意义(P>0.05),两组术后第1、3、7 d ALB含量比较差异有统计学意义(P<0.05)。结论肺叶切除术后患者会有免疫力下降,可导致较重的并发症如感染、多脏器功能不全等,因此术后的免疫状态应作为术后快速康复和综合治疗中的重要一部分。而VATS与PT对比,可减少术后免疫力及营养状态的下降,应将VATS作为治疗肺结核的微创手术方式推广。更多还原

【Abstract】 Objective To explore the effects of video-assisted thoracic surgery(VATS)and posterolateral thoracotomy(PT)on the immunity of patients with pulmonary tuberculosis.Methods Eighty-four patients undergoing pulmonary lobectomy in Second Department of Thoracic Surgery,Xinjiang Chest Hospital from January 2015 to December 2016 were selected and assigned in an non-random method.Test group included patients undergoing VATS and control group included patients undergoing PT.Peripheral venous blood was collected for cellular and humoral immunological tests from patients in both groups in the morning and at the 3d preoperatively,and at 1d,3d and7d postoperatively.The differences between two groups were analyzed.Results In cellular immunity results,there were no statistically significant differences between the VATS and PT groups in preoperative cellular immunity(P>0.05),and statistically significant differences between two groups in CD3 at 1d postoperatively,and CD3 and CD4~+ at 7d postoperatively(P<0.05).There were no statistically significant differences in humoral immunity results between the VATS and PT groups in preoperative humoral immunity(P>0.05),and statistically significant difference between two groups in IgA at 1d postoperatively.There were no statistically significant differences between the VATS and PT groups in preoperative nutritional status(P>0.05),and statistically significant differences between the two groups in ALB at 1d,3d,and 7d postoperatively.ConclusionThe patient’s immunity would decrease following pulmonary lobectomy,which may lead to severe complications such as infection and multiple organ dysfunction.The postoperative immune state is therefore an important component of postoperative fast rehabilitation and comprehensive treatment.Compared with PT,VATS could reduce the postoperative decline of immunity and nutritional status,supporting the further application of VATS as a minimally invasive surgical approach for pulmonary tuberculosis.更多还原