食道癌患者不同術式圍手術期IgG、IgM、IgA及T細胞亞群的水平變化分析
發(fā)布時間：2018-08-08 20:43
【摘要】：[目的]目前對于微創(chuàng)食道癌根治術與傳統(tǒng)食道癌根治術治療效果爭議頗多,故為對比微創(chuàng)食道癌根治術與傳統(tǒng)食道癌根治術臨床效果,我們選取臨床上與患者術后的恢復、術后并發(fā)癥的發(fā)生及術后的預后情況緊密相關的免疫指標來進行論證�；诖�,筆者擬比較胸腹腔鏡聯(lián)合食道癌根治術加頸部吻合術和傳統(tǒng)三切口手術對食道癌患者機體多種免疫功能的變化規(guī)律和相互關系,探討分析不同術式食道癌患者的IgG、IgM、IgA水平及T細胞亞群(CD3+、CD4+、CD8+)細胞濃度等免疫指標變化規(guī)律,為臨床判斷更適合的手術方法提供參考。[方法]1.臨床資料:回顧性分析2015年3月～2017年2月我院食道癌患者,有45例患者符合入組標準納入本研究,將患者分為腔鏡組(MIME)及傳統(tǒng)組(傳統(tǒng)開胸、開腹三切口食道癌手術);其中腔鏡組(26例)和傳統(tǒng)組(19例)。其中男34例,女11例;年齡48～75歲。其中,食道胸上段癌癥為5例,胸中段癌癥為16例,食道下段癌癥為24例。所有病例無胸、腹部手術史�；颊叩男詣e、年齡、腫瘤位置均無統(tǒng)計學差異(P0.05),試驗具有可比性。2、手術方式:均采用靜脈復合全身麻醉,雙腔氣管插管,為避免偏倚由同組醫(yī)師進行手術操作。2.1、腔鏡組:手術切口選擇采用腹腔5孔、胸腔3孔法,胸腔鏡游離食道,腹腔鏡游離胃,吻合口位于頸部(McKeown手術)。2.2、傳統(tǒng)組:患者采用傳統(tǒng)頸加右胸加腹正中三切口完成食道癌根治術,吻合口位于頸部(McKeown手術)。3方法及檢測指標3.1、方法及檢測指標T細胞亞群各項指標采用流式細胞學檢測,免疫球蛋白用BN Pro Sper特定蛋白儀檢測。3.2、實驗室資料血液標本的采集、制備、保存和檢測均按照嚴格的規(guī)范操作。收集所有患者患者術前3天及術后第2天、第7天的IgG、IgM、IgA水平及T細胞亞群(CD3+、CD4+、CD8+)細胞濃度,并進行對比分析。3.3、所有觀察數(shù)據(jù)應用SPSS 21.0軟件包做統(tǒng)計分析。[結果]1、體液免疫方面:術前3天兩組患者免疫球蛋白IgG、IgM和IgA水平差異無統(tǒng)計學意義(均P0.05)。術后第2天,兩組IgG、IgM和IgA水平較術前均降低(均P0.05),但傳統(tǒng)組與腔鏡組間免疫球蛋白水平均差異無統(tǒng)計學意義。術后第7天,兩組免疫球蛋白IgG、IgM和IgA水平較術后第2天均有所升高,但仍低于術前水平(均P0.05),且與傳統(tǒng)組相比,腔鏡組IgG、IgM和IgA水平明顯升高,差異有統(tǒng)計學意義(均P0.05)。2、細胞免疫方面:傳統(tǒng)組與腔鏡組患者術前3天的T細胞亞群CD3+、CD4+、CD8+、CD4+/CD8+含量的差異均無統(tǒng)計學意義(P0.05),術后第2天,傳統(tǒng)組與腔鏡組CD3+、CD4+、CD4+/CD8+含量較術前均有降低(P0.05),但兩組T細胞亞群含量之間的差異均無統(tǒng)計學意義。術后第7天,腔鏡組CD3+、CD4+、CD4+/CD8+含量均高于傳統(tǒng)組(P0.05)。術后第7天,傳統(tǒng)組的CD3+、CD4+、CD4+/CD8+含量比術后第2天要略微升高(P0.05),但明顯低于術前水平(P0.05);腔鏡組CD3+、CD4+、CD4+/CD8+含量逐漸升高,術后第7天CD3+含量與術前比較差異無統(tǒng)計學意義(P0.05)。[結論]1、本實驗表明無論是胸腹聯(lián)合腔鏡手術亦或是傳統(tǒng)三切口手術治療,均影響術后患者的免疫球蛋白含量。2、本實驗表明MIME手術對于患者體內(nèi)IgM激活補體和調(diào)理吞噬功能以及IgG固體補體和殺傷靶細胞的作用較傳統(tǒng)三切口手術輕微,更有利于患者的術后快速恢復。3、本實驗表明無論是MIME,亦或者是傳統(tǒng)三切口食道癌手術,T細胞亞群細胞濃度不同程度的降低,可見兩種術式均具有抑制患者的細胞免疫的作用。4、本實驗表明MIME手術對于患者T細胞亞群細胞濃度的作用較傳統(tǒng)三切口手術輕微,更有利于患者的術后快速恢復。5、本實驗表明手術創(chuàng)傷與術后免疫功能的恢復狀況有關,證明了以MIME手術為代表的微創(chuàng)手術對患者的創(chuàng)傷較傳統(tǒng)根治術小,在臨床效果上,尤其是患者術后的恢復狀況要優(yōu)于傳統(tǒng)三切口手術治療。
[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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
本文編號：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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.1
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