首页
全胸腔镜与后外侧开胸对肺癌患者免疫功能影响的对比研究
Immune Functions of Patients Following Lobectomy for Lung Cancers: a Comparative Study Between Video-assisted Thoracoscopic Surgery and Posterolateral Thoracotomy
-
摘要: 目的 比较全胸腔镜与后外侧开胸手术对非小细胞肺癌患者的早期创伤指标及免疫功能的影响。 方法 前瞻性连续收集2008年7月至2009年7月间于我科接受后外侧开胸(PLT组)或胸腔镜(VATS组)手术治疗的确诊或拟诊的临床早期非小细胞肺癌患者的临床资料,并采集血液标本。检查所有患者术前、术后24 h、术后72 h外周血血清中 C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、白细胞介素6(IL-6)及白细胞介素2受体(IL-2R)的浓度。检测术前、术后3 d及术后7 d外周血淋巴细胞(L)计数及淋巴细胞中CD4+T淋巴细胞、CD8+T淋巴细胞、自然杀伤细胞(NK)比例。对两组患者上述指标进行比较。 结果 共纳入103例非小细胞肺癌患者,其中VATS组51例,PLT组52例。VATS组患者术中失血量少于PLT组(P=0.001)。PLT组患者术后12 h时SAA浓度高于VATS组(P=0.006)。PLT组患者术后CD8+T比例较术前降低,差异有统计学意义(P<0.001),但VATS组患者术后CD8+T比例较术前减低幅度小,差异无统计学意义(P>0.05)。PLT组患者术后7 d时CD8+T比例低于VATS组(P=0.015)。 结论 与常规后外侧开胸手术相比较,单向式胸腔镜肺癌切除术可以降低患者术后急性期反应,减轻对患者免疫功能的抑制。Abstract: Objective To compare acute inflammatory responses and immunosuppression to lobectomy in lung cancer patients with video-assisted thoracoscopic surgery (VATS) and posterolateral thoracotomy (PLT). Methods A total of 103 patients who underwent either a VATS (n=51) or a PLT (n=52) lobectomy for early non-small cell lung cancers (NSCLC, stage Ⅰ) were recruited for this study. Blood samples of the participants were taken pre-operatively and at 24 h and 72 h post-operatively for analyses of C-reactive protein (CRP), interleukin (IL)-6, IL-2 receptors (IL-2R), and serum amyloid A (SAA). Blood samples taken pre-operatively and at 2 d and 7 d post operations were also analyzed for total lymphocytes, NK cells, CD4+T, and CD8+T. Results Patients in the VATS group lost significantly less blood than those in the PLT group (P=0.001). Patients in the PLT group had significantly higher serum SAA than those in the VATS group (P=0.006). Significant reduction of CD8+T was found in the patients with PLT after operations (P<0.01). Patients in the PLT group had significantly lower at CD8+T 7 d post operations than those in the VATS group (P=0.015). Conclusion VATS pulmonary lobectomy is associated with reduced acute inflammatory responses and immunosuppression compared with the PLT approach.
-
-
[1] Pollock RE, Lotzova E, Stanford SD. Surgical stress impairs natural killer cell programming of tumor for lysis in patients with sarcomas and other solid tumors. Cancer,1992;70(8):2192-2202.
[2] 刘伦旭, 车国卫, 王 允等. 电视胸腔镜手术治疗肺良性疾病128例. 中国胸心血管外科临床杂志,2008;15(1):29-31. [3] 蒲 强, 刘伦旭, 车国卫等. 单向式全胸腔镜肺叶切除手术治疗肺良性疾病的临床研究. 四川大学学报(医学版),2010;41(3):548-550. [4] Li WW, Lee RL, Lee TW, et al. The impact of thoracic surgical access on early shoulder function:video-assisted thoracic surgery versus posterolateral thoracotomy. Eur J Cardiothorac Surg,2003;23(3):390-396.
[5] Demmy TL, Nwogu C. Is video-assisted thoracic surgery lobectomy better? Quality of life considerations. Ann Thorac Surg,2008;85(2):S719-S728.
[6] Nagahiro I, Andou A, Aoe M, et al. Pulmonary function, postoperative pain, and serum cytokine level after lobectomy:a comparison of VATS and conventional procedure. Ann Thorac Surg,2001;72(2):362-365.
[7] Yan TD, Black D, Bannon PG, et al. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol,2009;27(15):2553-2562.
[8] Yim AP, Landreneau RJ, Izzat MB, et al. Is video-assisted thoracoscopic lobectomy a unified approach? Ann Thorac Surg,1998;66(4):1155-1158.
[9] 刘伦旭, 车国卫, 蒲 强等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志,2008;24(3):156-158. [10] Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: single-direction thoracoscopic lobectomy. Surg Oncol,2010;19(2):e71-e77.
[12] Yim APC, Wan S, Lee TW, et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg,2000;70(1):243-247.
[13] Craig SR, Leaver HA, Yap PL, et al. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg,2001;20(3):455-463.
[14] Leaver HA, Craig SR, Yap PL, et al. Lymphocyte responses following open and minimally invasive thoracic surgery. Eur J Clin Invest,2000;30(3):230-238.
[15] Whitson BA, D’Cunha J, Andrade RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy:differential impairment of cellular immunity. Ann Thorac Surg,2008;86(6):1735-1744.
计量
- 文章访问数: 2784
- HTML全文浏览量: 240
- PDF下载量: 168
下载:
