食道癌患者不同术式围手术期IgG、IgM、IgA及T细胞亚群的水平变化分析
发布时间：2018-08-08 20:43
【摘要】：[目的]目前对于微创食道癌根治术与传统食道癌根治术治疗效果争议颇多,故为对比微创食道癌根治术与传统食道癌根治术临床效果,我们选取临床上与患者术后的恢复、术后并发症的发生及术后的预后情况紧密相关的免疫指标来进行论证。基于此,笔者拟比较胸腹腔镜联合食道癌根治术加颈部吻合术和传统三切口手术对食道癌患者机体多种免疫功能的变化规律和相互关系,探讨分析不同术式食道癌患者的IgG、IgM、IgA水平及T细胞亚群(CD3+、CD4+、CD8+)细胞浓度等免疫指标变化规律,为临床判断更适合的手术方法提供参考。[方法]1.临床资料:回顾性分析2015年3月～2017年2月我院食道癌患者,有45例患者符合入组标准纳入本研究,将患者分为腔镜组(MIME)及传统组(传统开胸、开腹三切口食道癌手术);其中腔镜组(26例)和传统组(19例)。其中男34例,女11例;年龄48～75岁。其中,食道胸上段癌症为5例,胸中段癌症为16例,食道下段癌症为24例。所有病例无胸、腹部手术史。患者的性别、年龄、肿瘤位置均无统计学差异(P0.05),试验具有可比性。2、手术方式:均采用静脉复合全身麻醉,双腔气管插管,为避免偏倚由同组医师进行手术操作。2.1、腔镜组:手术切口选择采用腹腔5孔、胸腔3孔法,胸腔镜游离食道,腹腔镜游离胃,吻合口位于颈部(McKeown手术)。2.2、传统组:患者采用传统颈加右胸加腹正中三切口完成食道癌根治术,吻合口位于颈部(McKeown手术)。3方法及检测指标3.1、方法及检测指标T细胞亚群各项指标采用流式细胞学检测,免疫球蛋白用BN Pro Sper特定蛋白仪检测。3.2、实验室资料血液标本的采集、制备、保存和检测均按照严格的规范操作。收集所有患者患者术前3天及术后第2天、第7天的IgG、IgM、IgA水平及T细胞亚群(CD3+、CD4+、CD8+)细胞浓度,并进行对比分析。3.3、所有观察数据应用SPSS 21.0软件包做统计分析。[结果]1、体液免疫方面:术前3天两组患者免疫球蛋白IgG、IgM和IgA水平差异无统计学意义(均P0.05)。术后第2天,两组IgG、IgM和IgA水平较术前均降低(均P0.05),但传统组与腔镜组间免疫球蛋白水平均差异无统计学意义。术后第7天,两组免疫球蛋白IgG、IgM和IgA水平较术后第2天均有所升高,但仍低于术前水平(均P0.05),且与传统组相比,腔镜组IgG、IgM和IgA水平明显升高,差异有统计学意义(均P0.05)。2、细胞免疫方面:传统组与腔镜组患者术前3天的T细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+含量的差异均无统计学意义(P0.05),术后第2天,传统组与腔镜组CD3+、CD4+、CD4+/CD8+含量较术前均有降低(P0.05),但两组T细胞亚群含量之间的差异均无统计学意义。术后第7天,腔镜组CD3+、CD4+、CD4+/CD8+含量均高于传统组(P0.05)。术后第7天,传统组的CD3+、CD4+、CD4+/CD8+含量比术后第2天要略微升高(P0.05),但明显低于术前水平(P0.05);腔镜组CD3+、CD4+、CD4+/CD8+含量逐渐升高,术后第7天CD3+含量与术前比较差异无统计学意义(P0.05)。[结论]1、本实验表明无论是胸腹联合腔镜手术亦或是传统三切口手术治疗,均影响术后患者的免疫球蛋白含量。2、本实验表明MIME手术对于患者体内IgM激活补体和调理吞噬功能以及IgG固体补体和杀伤靶细胞的作用较传统三切口手术轻微,更有利于患者的术后快速恢复。3、本实验表明无论是MIME,亦或者是传统三切口食道癌手术,T细胞亚群细胞浓度不同程度的降低,可见两种术式均具有抑制患者的细胞免疫的作用。4、本实验表明MIME手术对于患者T细胞亚群细胞浓度的作用较传统三切口手术轻微,更有利于患者的术后快速恢复。5、本实验表明手术创伤与术后免疫功能的恢复状况有关,证明了以MIME手术为代表的微创手术对患者的创伤较传统根治术小,在临床效果上,尤其是患者术后的恢复状况要优于传统三切口手术治疗。
[Abstract]:[Objective] at present, there are many disputes over the curative effect of minimally invasive esophagus cancer radical mastectomy and traditional esophagus cancer radical mastectomy. Therefore, we compare the clinical effects of minimally invasive esophagectomy and traditional esophagus cancer radical mastectomy. We select the immune indexes closely related to postoperative recovery, postoperative complications and postoperative prognosis. On the basis of this, the author intends to compare the changes in the immune function of the patients with esophageal cancer and the relationship between the thoracic laparoscopy combined with radical resection of esophagus carcinoma and the traditional three incision operation on the immune function of the patients with esophageal cancer, and discuss the immunization of IgG, IgM, IgA and T cell subsets (CD3+, CD4+, CD8+) cell concentration in the patients with different surgical esophagus cancer. The rule of index change provides a reference for the more suitable surgical methods for clinical judgment. [method]1. clinical data: retrospective analysis of the esophageal cancer patients in our hospital from March 2015 to February 2017. 45 patients were included in the study. The patients were divided into the endoscopic group (MIME) and the traditional group (traditional open chest, open three incision esophagus cancer surgery); The endoscopic group (26 cases) and the traditional group (19 cases) were 34 men, 11 women and 48~75 years old. Among them, the cancer of the upper thoracic section of the esophagus was 5, the middle thoracic cancer was 16, the lower esophageal cancer was 24. All cases had no chest, abdominal operation history. The sex, age, and tumor position of the patients were not statistically different (P0.05), the test had comparable.2, operation mode. Both intravenous combined general anesthesia and double lumen tracheal intubation were used to avoid the bias by the same group of surgeons to operate.2.1. Endoscopic group: surgical incision selected 5 holes in the abdominal cavity, 3 holes in the thoracic cavity, thoracoscopic free esophagus, laparoscopic free stomach, and the anastomotic mouth in the neck (McKeown operation).2.2. Traditional group: the traditional neck plus right chest plus abdominal positive with the right chest. The middle three incision completed the esophagus cancer radical operation, the anastomosis was located in the neck (McKeown operation).3 method and the detection index 3.1, the method and the detection index T cell subgroup each index uses the flow cytology test, the immunoglobulin uses the BN Pro Sper specific protein instrument to detect.3.2, the laboratory funded blood specimen collection, preparation, preservation and detection are all according to Strict standardized operation. The concentration of IgG, IgM, IgA and T cell subsets (CD3+, CD4+, CD8+) cells in all patients 3 days before and second days after operation and seventh days of T cell subgroup (CD3+, CD4+, CD8+) cell concentration and comparative analysis.3.3, all observation data using SPSS 21 software package for statistical analysis. [results] 1, humoral immunity: two groups of patients immunoglobulin IgG, 3 days before operation, The levels of IgM and IgA were not statistically significant (P0.05). The level of IgG, IgM and IgA decreased in the two groups second days after the operation (P0.05), but there was no significant difference in the level of immunoglobulin between the traditional and the endoscopy groups. The level of the two groups of immunoglobulin IgG, IgM and IgA increased at the seventh day after the operation, but it was still lower than that before the operation. Compared with the traditional group, the level of IgG, IgM and IgA increased significantly compared with the traditional group, and the difference was statistically significant (P0.05).2. Cellular immunity: there was no significant difference between the T cell subgroup CD3+, CD4+, CD8+, and CD4+/CD8+ in the traditional group and the endoscopic group 3 days before the operation (P0.05), the second day after the operation, the traditional group and the endoscopy group were the same. The content of 4+, CD4+/CD8+ was lower than that before operation (P0.05), but there was no significant difference between the two groups of T cell subsets. The content of CD3+, CD4+ and CD4+/CD8+ in the endoscopic group was higher than that of the traditional group (P0.05) on the seventh day after the operation. The CD3+, CD4+, CD4+/CD8+ content of the traditional group was slightly higher than that of the second days after the operation (P0.05), but it was obviously lower than that before the operation. Level (P0.05); the content of CD3+, CD4+, CD4+/CD8+ in endoscopic group increased gradually. There was no significant difference between CD3+ content and preoperative seventh days after operation (P0.05). [conclusion]1, this experiment showed that both thoraco abdominal combined endoscopic surgery or traditional three incision surgery affected the immunoglobulin content.2 in postoperative patients, and this experiment showed MIME operation. The effect of IgM activating complement and regulating phagocytosis and IgG solid complement and killing target cells is less than the traditional three incision operation, which is more conducive to the rapid recovery of.3 after operation. This experiment shows that the concentration of T cell subgroup cells is reduced in different degrees, whether it is MIME, or the traditional three incision esophagus cancer operation. The effect of the two types of operation on the cell immunity of the patients was.4. This experiment showed that the effect of MIME operation on the cell concentration of T cells in patients was less than that of the traditional three incision operation, which was more conducive to the rapid recovery of.5 after the operation. This experiment showed that the operation trauma was related to the recovery of the immune function after the operation, which proved that the operation of MIME was performed by MIME operation. The minimally invasive surgery for the patients is smaller than the traditional radical operation. In the clinical effect, the recovery of the patients, especially after the operation, is better than the traditional three incision operation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1
本文编号：2172982
[Abstract]:[Objective] at present, there are many disputes over the curative effect of minimally invasive esophagus cancer radical mastectomy and traditional esophagus cancer radical mastectomy. Therefore, we compare the clinical effects of minimally invasive esophagectomy and traditional esophagus cancer radical mastectomy. We select the immune indexes closely related to postoperative recovery, postoperative complications and postoperative prognosis. On the basis of this, the author intends to compare the changes in the immune function of the patients with esophageal cancer and the relationship between the thoracic laparoscopy combined with radical resection of esophagus carcinoma and the traditional three incision operation on the immune function of the patients with esophageal cancer, and discuss the immunization of IgG, IgM, IgA and T cell subsets (CD3+, CD4+, CD8+) cell concentration in the patients with different surgical esophagus cancer. The rule of index change provides a reference for the more suitable surgical methods for clinical judgment. [method]1. clinical data: retrospective analysis of the esophageal cancer patients in our hospital from March 2015 to February 2017. 45 patients were included in the study. The patients were divided into the endoscopic group (MIME) and the traditional group (traditional open chest, open three incision esophagus cancer surgery); The endoscopic group (26 cases) and the traditional group (19 cases) were 34 men, 11 women and 48~75 years old. Among them, the cancer of the upper thoracic section of the esophagus was 5, the middle thoracic cancer was 16, the lower esophageal cancer was 24. All cases had no chest, abdominal operation history. The sex, age, and tumor position of the patients were not statistically different (P0.05), the test had comparable.2, operation mode. Both intravenous combined general anesthesia and double lumen tracheal intubation were used to avoid the bias by the same group of surgeons to operate.2.1. Endoscopic group: surgical incision selected 5 holes in the abdominal cavity, 3 holes in the thoracic cavity, thoracoscopic free esophagus, laparoscopic free stomach, and the anastomotic mouth in the neck (McKeown operation).2.2. Traditional group: the traditional neck plus right chest plus abdominal positive with the right chest. The middle three incision completed the esophagus cancer radical operation, the anastomosis was located in the neck (McKeown operation).3 method and the detection index 3.1, the method and the detection index T cell subgroup each index uses the flow cytology test, the immunoglobulin uses the BN Pro Sper specific protein instrument to detect.3.2, the laboratory funded blood specimen collection, preparation, preservation and detection are all according to Strict standardized operation. The concentration of IgG, IgM, IgA and T cell subsets (CD3+, CD4+, CD8+) cells in all patients 3 days before and second days after operation and seventh days of T cell subgroup (CD3+, CD4+, CD8+) cell concentration and comparative analysis.3.3, all observation data using SPSS 21 software package for statistical analysis. [results] 1, humoral immunity: two groups of patients immunoglobulin IgG, 3 days before operation, The levels of IgM and IgA were not statistically significant (P0.05). The level of IgG, IgM and IgA decreased in the two groups second days after the operation (P0.05), but there was no significant difference in the level of immunoglobulin between the traditional and the endoscopy groups. The level of the two groups of immunoglobulin IgG, IgM and IgA increased at the seventh day after the operation, but it was still lower than that before the operation. Compared with the traditional group, the level of IgG, IgM and IgA increased significantly compared with the traditional group, and the difference was statistically significant (P0.05).2. Cellular immunity: there was no significant difference between the T cell subgroup CD3+, CD4+, CD8+, and CD4+/CD8+ in the traditional group and the endoscopic group 3 days before the operation (P0.05), the second day after the operation, the traditional group and the endoscopy group were the same. The content of 4+, CD4+/CD8+ was lower than that before operation (P0.05), but there was no significant difference between the two groups of T cell subsets. The content of CD3+, CD4+ and CD4+/CD8+ in the endoscopic group was higher than that of the traditional group (P0.05) on the seventh day after the operation. The CD3+, CD4+, CD4+/CD8+ content of the traditional group was slightly higher than that of the second days after the operation (P0.05), but it was obviously lower than that before the operation. Level (P0.05); the content of CD3+, CD4+, CD4+/CD8+ in endoscopic group increased gradually. There was no significant difference between CD3+ content and preoperative seventh days after operation (P0.05). [conclusion]1, this experiment showed that both thoraco abdominal combined endoscopic surgery or traditional three incision surgery affected the immunoglobulin content.2 in postoperative patients, and this experiment showed MIME operation. The effect of IgM activating complement and regulating phagocytosis and IgG solid complement and killing target cells is less than the traditional three incision operation, which is more conducive to the rapid recovery of.3 after operation. This experiment shows that the concentration of T cell subgroup cells is reduced in different degrees, whether it is MIME, or the traditional three incision esophagus cancer operation. The effect of the two types of operation on the cell immunity of the patients was.4. This experiment showed that the effect of MIME operation on the cell concentration of T cells in patients was less than that of the traditional three incision operation, which was more conducive to the rapid recovery of.5 after the operation. This experiment showed that the operation trauma was related to the recovery of the immune function after the operation, which proved that the operation of MIME was performed by MIME operation. The minimally invasive surgery for the patients is smaller than the traditional radical operation. In the clinical effect, the recovery of the patients, especially after the operation, is better than the traditional three incision operation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.1
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