肺癌根治术式对老年肺癌病人围术期T淋巴细胞亚群及肿瘤微转移的影响  

Effect of different radical operations for lung cancer on perioperative T lymphocyte subsets and tumor micrometastasis in elderly patients with lung cancer

作　　者：李冬冬 楚社录[1] LI Dongdong;CHU Shelu(Department of Thoracic Surgery,Sanmenxia Central Hospital,Sanmenxia,Henan 472000,China)

机构地区：[1]三门峡市中心医院胸外科,河南三门峡472000

出　　处：《安徽医药》2019年第5期976-980,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨胸腔镜下肺癌根治术与传统开胸肺癌根治术对老年肺癌病人围术期T淋巴细胞亚群及肿瘤微转移的影响。方法 2015年6月至2017年6月三门峡市中心医院收治的限期行肺癌根治术病人,选取75例行胸腔镜肺癌根治术病人作为胸腔镜组,93例行传统开胸肺癌根治术病人为开胸组,比较两组手术情况、术后疼痛视觉模拟评分(VAS)、T淋巴细胞亚群、NK细胞水平及基质金属蛋白酶-7mRNA(MMPs-7mRNA)、可溶性主要组织相容性复合体I类相关分子A(sMICA)、血管内皮生长因子(VEGF)表达水平。结果两组手术时间、淋巴结清扫数目比较差异无统计学意义(P>0.05);胸腔镜组较开胸组术中出血量、术后引流管放置时间、术后引流量及术后住院时间均明显减少(P<0.05),术后并发症发生率明显降低(P<0.05)。胸腔镜组术后1 d、术后3 d、术后7 d的疼痛VAS评分均明显低于开胸组(P<0.05)。术后3 d,胸腔镜组CD4+、CD8+、NK细胞及CD4+/CD8+水平分别为(32.46±4.21)%、(27.69±3.57)%、(23.15±4.45)%、(1.17±0.23),均明显高于开胸组的(27.57±2.79)%、(22.28±3.49)%、(20.11±3.12)%、(0.97±0.26),差异有统计学意义(P<0.05)。术后3 d,胸腔镜组MMP-7mRNA、sMICA、VEGF水平分别为(20.41±4.56)、(291.54±67.87)pg/mL、(1.64±0.43)ng/mL,均明显低于开胸组的(24.55±5.36)、(322.58±74.43)pg/mL、(1.89±0.51)ng/mL,差异有统计学意义(P<0.05)。结论胸腔镜肺癌根治术治疗较传统开胸肺癌根治术可能有着一定优势,能够促进围术期免疫功能恢复,降低血清肿瘤微转移因子水平。Objective To investigate the influence of thoracoscopic radical resection of lung cancer and traditional thoracotomy and radical resection of lung cancer on T lymphocyte subsets and tumor micrometastasis in elderly patients with lung cancer.Methods During June 2015 to June 2017 in Sanmenxia Central Hospital,seventy-five patients undergoing thoracoscopic radical resection of lung cancer were selected as the thoracoscopic group and 93 patients undergoing traditional thoracotomy and radical resection of lung cancer were selected as the thoracotomy group.The situation of operation,postoperative pain visual analogue scale(VAS)scores,levels of T lymphocyte subsets and NK cells,expression levels of matrix metalloproteinase-7 mRNA(MMPs-7mRNA),soluble major histocompatibility complexclass I-related chain A(sMICA)and vascular endothelial growth factor(VEGF)were compared between the two groups.Results There was no significant difference between the two groups in opera-tion time and the number of cleaned lymph nodes(P>0.05).The intraoperative blood loss,postoperative drainage tube indwelling time,postoperative drainage volume and postoperative length of hospital stay of the thoracoscopic group were significantly less/shorter than those of the thoracotomy group(P<0.05).The incidence of postoperative complications was significantly lower than that in the thoracotomy group(P<0.05).The pain VAS scores of thoracoscopic group at 1 d,3 d and 7 d after operation were significantly lower than those of the thoracotomy group(P<0.05).The levels of CD+4,CD+8,NK cells and CD+4/CD+8 in the thoraco-scopic group[(32.46±4.21)%,(27.69±3.57)%,(23.15±4.45)%,(1.17±0.23)]were significantly higher than those in the thora-cotomy group[(27.57±2.79)%,(22.28±3.49)%,(20.11±3.12)%,(0.97±0.26)]at 3d after operation(P<0.05).The levels of MMP-7 mRNA,sMICA and VEGF in the thoracoscopic group[(20.41±4.56),(291.54±67.87)pg/mL,(1.64±0.43)ng/mL]were significantly lower than those in the thoracotomy group[(24.55±5.36),(322.58±74.43)pg/mL,(1.89±0.51)

关 键 词：肺肿瘤 肺切除术 胸腔镜检查 肿瘤微转移 T淋巴细胞亚群 基质金属蛋白酶7 主要组织相容性复合物 血管内皮生长因子类 杀伤细胞 天然 老年人 

分 类 号：R734.2[医药卫生—肿瘤]