食管癌不同手術(shù)方式對患者術(shù)后體液及細(xì)胞免疫功能的影響
發(fā)布時間：2018-12-15 10:17
【摘要】：目的 研究探討胸腔鏡手術(shù)治療(Video-assisted Thoracic Surgery, VATS)和傳統(tǒng)手術(shù)治療下食管癌患者機體多種免疫功能的變化規(guī)律和相互關(guān)系,從免疫機制的角度客觀分析胸腔鏡手術(shù)治療在治療食管癌上的優(yōu)勢。方法2014年3月至2014年9月選取安徽醫(yī)科大學(xué)第一附屬醫(yī)院普胸外科一病區(qū)51例住院并有完整病例資料的食管癌患者,其中傳統(tǒng)手術(shù)治療組35例,胸腔鏡手術(shù)治療16例。分別檢測患者術(shù)前、術(shù)后第1天(d)、術(shù)后第6天(d) IgA、IgM、IgG、補體C3、補體C4、CRP(C-反應(yīng)蛋白)水平及T細(xì)胞亞群(CD3+、CD4+、CD8+)及NK細(xì)胞含量。結(jié)果1.傳統(tǒng)組與VATS組患者術(shù)前免疫球蛋白IgA、IgG和IgM、CRP水平無統(tǒng)計學(xué)差異(均有P0.05)。術(shù)后第1d,傳統(tǒng)組與VATS組IgA、IgG和IgM水平較術(shù)前均降低(均有P0.05), CRP水平較術(shù)前均升高,但傳統(tǒng)組與VATS組間免疫球蛋白水平均無統(tǒng)計學(xué)差異(均有P0.05)。術(shù)后第6d,兩組免疫球蛋白IgA、IgG和IgM水平較術(shù)后第1d均有所升高,但仍低于術(shù)前水平(均有P0.05), CRP水平較術(shù)后第1d均有所下降,但仍高于術(shù)前水平(均有P0.05),且與傳統(tǒng)組相比,VATS組IgA、IgG和IgM水平明顯升高,CRP水平明顯降低,差異有統(tǒng)計學(xué)意義(均有P0.05)。而對于補體C3.C4,傳統(tǒng)組與VATS組患者術(shù)前補體C3、C4水平無統(tǒng)計學(xué)差異(均有P0.05)。術(shù)后第1d,傳統(tǒng)組與VATS組補體C3、C4水平較術(shù)前無明顯變化(均有P.0.05),傳統(tǒng)組與VATS組間免疫球蛋白水平均也無統(tǒng)計學(xué)差異。術(shù)后第6d,兩組補體C3、C4水平較術(shù)前、術(shù)后第1d均無明顯變化(均有P0.05),且與傳統(tǒng)組相比,VATS組差異無統(tǒng)計學(xué)意義(均有P0.05)。2.術(shù)前兩組患者的T淋巴細(xì)胞亞群CD3+、CD4+、CD8+、CD4+/CD8+及NK細(xì)胞含量的差異均無統(tǒng)計學(xué)意義(P0.05)。術(shù)后第1d,無論是傳統(tǒng)組還是VATS組,CD3+、CD4+、CD4+/CD8+及NK細(xì)胞含量水平較術(shù)前均降低(P0.05),而CD8+細(xì)胞含量水平較術(shù)前均有所升高(P0.05)。但兩組之間的T淋巴細(xì)胞亞群和NK細(xì)胞含量之間的差異均無統(tǒng)計學(xué)意義。術(shù)后第6d,傳統(tǒng)組的CD3+、CD4+、CD4+/CD8+及NK細(xì)胞含量水平比術(shù)后第1d要略微升高(P0.05),但明顯低于術(shù)前水平(P0.05),CD8+細(xì)胞含量水平比術(shù)后第1d要略微降低(P0.05),但仍要高于術(shù)前水平(P0.05)；VATS組CD3+、CD4+、CD4+/CD8+及NK細(xì)胞含量的水平逐漸升高,術(shù)后第6d CD3+及NK細(xì)胞含量水平與術(shù)前比較差異無統(tǒng)計學(xué)意義(P0.05),CD8+細(xì)胞含量水平比術(shù)后第1d要略微降低(P0.05),已經(jīng)基本接近術(shù)前水平(P0.05)。兩組各項檢測數(shù)據(jù)之間的比較可以得出,術(shù)后第6d, VATS組CD3+、CD4+、CD4+/CD8+及NK細(xì)胞含量水平均高于傳統(tǒng)組(P0.05),而CD8+細(xì)胞含量水平要低于傳統(tǒng)組(P0.05)。結(jié)論 1.食道癌患者細(xì)胞免疫及體液免疫功能均受手術(shù)創(chuàng)傷刺激的影響,而補體所受影響較小。2.胸腔鏡手術(shù)治療對食管癌患者的創(chuàng)傷較小,對術(shù)后病人的免疫水平影響較傳統(tǒng)根治術(shù)小,病后恢復(fù)優(yōu)于傳統(tǒng)根治術(shù)。
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.1
本文編號：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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.1
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