食管癌不同手术方式对患者术后体液及细胞免疫功能的影响
发布时间：2018-12-15 10:17
【摘要】：目的 研究探讨胸腔镜手术治疗(Video-assisted Thoracic Surgery, VATS)和传统手术治疗下食管癌患者机体多种免疫功能的变化规律和相互关系,从免疫机制的角度客观分析胸腔镜手术治疗在治疗食管癌上的优势。方法2014年3月至2014年9月选取安徽医科大学第一附属医院普胸外科一病区51例住院并有完整病例资料的食管癌患者,其中传统手术治疗组35例,胸腔镜手术治疗16例。分别检测患者术前、术后第1天(d)、术后第6天(d) IgA、IgM、IgG、补体C3、补体C4、CRP(C-反应蛋白)水平及T细胞亚群(CD3+、CD4+、CD8+)及NK细胞含量。结果1.传统组与VATS组患者术前免疫球蛋白IgA、IgG和IgM、CRP水平无统计学差异(均有P0.05)。术后第1d,传统组与VATS组IgA、IgG和IgM水平较术前均降低(均有P0.05), CRP水平较术前均升高,但传统组与VATS组间免疫球蛋白水平均无统计学差异(均有P0.05)。术后第6d,两组免疫球蛋白IgA、IgG和IgM水平较术后第1d均有所升高,但仍低于术前水平(均有P0.05), CRP水平较术后第1d均有所下降,但仍高于术前水平(均有P0.05),且与传统组相比,VATS组IgA、IgG和IgM水平明显升高,CRP水平明显降低,差异有统计学意义(均有P0.05)。而对于补体C3.C4,传统组与VATS组患者术前补体C3、C4水平无统计学差异(均有P0.05)。术后第1d,传统组与VATS组补体C3、C4水平较术前无明显变化(均有P.0.05),传统组与VATS组间免疫球蛋白水平均也无统计学差异。术后第6d,两组补体C3、C4水平较术前、术后第1d均无明显变化(均有P0.05),且与传统组相比,VATS组差异无统计学意义(均有P0.05)。2.术前两组患者的T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+及NK细胞含量的差异均无统计学意义(P0.05)。术后第1d,无论是传统组还是VATS组,CD3+、CD4+、CD4+/CD8+及NK细胞含量水平较术前均降低(P0.05),而CD8+细胞含量水平较术前均有所升高(P0.05)。但两组之间的T淋巴细胞亚群和NK细胞含量之间的差异均无统计学意义。术后第6d,传统组的CD3+、CD4+、CD4+/CD8+及NK细胞含量水平比术后第1d要略微升高(P0.05),但明显低于术前水平(P0.05),CD8+细胞含量水平比术后第1d要略微降低(P0.05),但仍要高于术前水平(P0.05)；VATS组CD3+、CD4+、CD4+/CD8+及NK细胞含量的水平逐渐升高,术后第6d CD3+及NK细胞含量水平与术前比较差异无统计学意义(P0.05),CD8+细胞含量水平比术后第1d要略微降低(P0.05),已经基本接近术前水平(P0.05)。两组各项检测数据之间的比较可以得出,术后第6d, VATS组CD3+、CD4+、CD4+/CD8+及NK细胞含量水平均高于传统组(P0.05),而CD8+细胞含量水平要低于传统组(P0.05)。结论 1.食道癌患者细胞免疫及体液免疫功能均受手术创伤刺激的影响,而补体所受影响较小。2.胸腔镜手术治疗对食管癌患者的创伤较小,对术后病人的免疫水平影响较传统根治术小,病后恢复优于传统根治术。
[Abstract]:Objective to investigate the changes of multiple immune functions in patients with esophageal carcinoma treated by thoracoscopic surgery (Video-assisted Thoracic Surgery, VATS) and conventional surgery. Objective analysis of the advantages of thoracoscopic surgery in the treatment of esophageal cancer from the point of view of immune mechanism. Methods from March 2014 to September 2014, 51 patients with esophageal cancer were selected from the first affiliated Hospital of Anhui Medical University, Department of General Thoracic surgery, including 35 cases in the traditional surgical treatment group and 16 cases in the thoracoscopic surgery group. The levels of (d) IgA,IgM,IgG, complement C _ 3, C _ 4 CRP (C _ reactive protein), CD3, CD4 (CD8) and NK cell content were measured before and on the first day after (d),. Result 1. There was no significant difference in preoperative immunoglobulin IgA,IgG and IgM,CRP levels between the traditional group and the VATS group (P0.05). On the 1st day after operation, the levels of IgA,IgG and IgM in traditional group and VATS group were lower than those before operation (P0.05), CRP level was higher than that before operation, but there was no significant difference between traditional group and VATS group (P0.05). On the 6th day after operation, the levels of immunoglobulin IgA,IgG and IgM in both groups were higher than those in the first day after operation, but still lower than those before operation (P0.05), CRP level was lower than that at the first day after operation, but still higher than that before operation (P0.05). Compared with the traditional group, the levels of IgA,IgG and IgM in VATS group were significantly higher than those in the traditional group, and the CRP level was significantly decreased (P0.05). For complement C 3. C 4, there was no significant difference between the traditional group and the VATS group in the level of complement C 3 C 4 before operation (P0.05). On the 1st day after operation, the level of complement C _ 3 C _ 4 in the traditional group and the VATS group was not significantly different from that in the preoperative group (P 0.05), and there was no significant difference in the level of immunoglobulin between the traditional group and the VATS group. On the 6th day after operation, the level of complement C _ 3 C _ 4 in the two groups was significantly higher than that before operation, and on the 1st day after operation, there was no significant change (P0.05), and there was no significant difference between the VATS group and the traditional group (P0.05). There was no significant difference in T lymphocyte subsets (CD3, CD4, CD8, CD4 / CD8 and NK cells) between the two groups before operation (P0.05). On the 1st day after operation, the levels of CD3, CD4, CD4 / CD8 and NK cells in both traditional group and VATS group were lower than those before operation (P0.05), but CD8 cell content was higher than that before operation (P0.05). However, there was no significant difference in T lymphocyte subsets and NK cell contents between the two groups. On the 6th day after operation, the levels of CD3, CD4, CD4 / CD8 and NK cells in the traditional group were slightly higher than those in the first day after operation (P0.05), but significantly lower than those before operation (P0.05). The content of CD8 cells was slightly lower than that of the first day after operation (P0.05), but still higher than the preoperative level (P0.05). The levels of CD3, CD4, CD4 / CD8 and NK cells increased gradually in VATS group, and there was no significant difference in CD3 and NK cell levels between before and after operation on the 6th day after operation (P0.05). The content of CD8 cells was slightly lower than that on the 1st day after operation (P0.05), which was close to the preoperative level (P0.05). On the 6th day after operation, the levels of CD3, CD4, CD4 / CD8 and NK cells in the VATS group were higher than those in the traditional group (P0.05), while the CD8 cell content was lower than that in the traditional group (P0.05). Conclusion 1. The cellular and humoral immune function of patients with esophageal cancer was affected by surgical trauma stimulation, while the effect of complement was less. 2. 2. The effect of thoracoscopic surgery on the immune level of patients with esophageal cancer was less than that of traditional radical surgery, and the postoperative recovery was better than that of traditional radical surgery.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1
本文编号：2380470
[Abstract]:Objective to investigate the changes of multiple immune functions in patients with esophageal carcinoma treated by thoracoscopic surgery (Video-assisted Thoracic Surgery, VATS) and conventional surgery. Objective analysis of the advantages of thoracoscopic surgery in the treatment of esophageal cancer from the point of view of immune mechanism. Methods from March 2014 to September 2014, 51 patients with esophageal cancer were selected from the first affiliated Hospital of Anhui Medical University, Department of General Thoracic surgery, including 35 cases in the traditional surgical treatment group and 16 cases in the thoracoscopic surgery group. The levels of (d) IgA,IgM,IgG, complement C _ 3, C _ 4 CRP (C _ reactive protein), CD3, CD4 (CD8) and NK cell content were measured before and on the first day after (d),. Result 1. There was no significant difference in preoperative immunoglobulin IgA,IgG and IgM,CRP levels between the traditional group and the VATS group (P0.05). On the 1st day after operation, the levels of IgA,IgG and IgM in traditional group and VATS group were lower than those before operation (P0.05), CRP level was higher than that before operation, but there was no significant difference between traditional group and VATS group (P0.05). On the 6th day after operation, the levels of immunoglobulin IgA,IgG and IgM in both groups were higher than those in the first day after operation, but still lower than those before operation (P0.05), CRP level was lower than that at the first day after operation, but still higher than that before operation (P0.05). Compared with the traditional group, the levels of IgA,IgG and IgM in VATS group were significantly higher than those in the traditional group, and the CRP level was significantly decreased (P0.05). For complement C 3. C 4, there was no significant difference between the traditional group and the VATS group in the level of complement C 3 C 4 before operation (P0.05). On the 1st day after operation, the level of complement C _ 3 C _ 4 in the traditional group and the VATS group was not significantly different from that in the preoperative group (P 0.05), and there was no significant difference in the level of immunoglobulin between the traditional group and the VATS group. On the 6th day after operation, the level of complement C _ 3 C _ 4 in the two groups was significantly higher than that before operation, and on the 1st day after operation, there was no significant change (P0.05), and there was no significant difference between the VATS group and the traditional group (P0.05). There was no significant difference in T lymphocyte subsets (CD3, CD4, CD8, CD4 / CD8 and NK cells) between the two groups before operation (P0.05). On the 1st day after operation, the levels of CD3, CD4, CD4 / CD8 and NK cells in both traditional group and VATS group were lower than those before operation (P0.05), but CD8 cell content was higher than that before operation (P0.05). However, there was no significant difference in T lymphocyte subsets and NK cell contents between the two groups. On the 6th day after operation, the levels of CD3, CD4, CD4 / CD8 and NK cells in the traditional group were slightly higher than those in the first day after operation (P0.05), but significantly lower than those before operation (P0.05). The content of CD8 cells was slightly lower than that of the first day after operation (P0.05), but still higher than the preoperative level (P0.05). The levels of CD3, CD4, CD4 / CD8 and NK cells increased gradually in VATS group, and there was no significant difference in CD3 and NK cell levels between before and after operation on the 6th day after operation (P0.05). The content of CD8 cells was slightly lower than that on the 1st day after operation (P0.05), which was close to the preoperative level (P0.05). On the 6th day after operation, the levels of CD3, CD4, CD4 / CD8 and NK cells in the VATS group were higher than those in the traditional group (P0.05), while the CD8 cell content was lower than that in the traditional group (P0.05). Conclusion 1. The cellular and humoral immune function of patients with esophageal cancer was affected by surgical trauma stimulation, while the effect of complement was less. 2. 2. The effect of thoracoscopic surgery on the immune level of patients with esophageal cancer was less than that of traditional radical surgery, and the postoperative recovery was better than that of traditional radical surgery.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.1
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