腔镜下免充气甲状腺手术对患者特异性免疫功能和炎性反应的影响  

Effect of endoscopic inflation-free thyroid surgery on patient-specific immune function and inflammatory response

作　　者：杨振 王南海[1] 金功圣[2] 王志 刘梦雅 徐直 Yang Zhen;Wang Nanhai;Jin Gongsheng;Wang Zhi;Liu Mengya;Xu Zhi(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Surgical Oncology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院麻醉科,蚌埠233004 [2]蚌埠医学院第一附属医院肿瘤外科,蚌埠233004

出　　处：《中国综合临床》2023年第6期459-466,共8页Clinical Medicine of China

基　　金：安徽省重点研究与开发计划项目 (202004j07020009)。

摘　　要：目的探讨腔镜下免充气甲状腺手术对患者特异性免疫功能和炎性反应的影响。方法本研究为前瞻性病例对照研究。选取蚌埠医学院第一附属医院2021年1月至2023年5月收治的甲状腺结节患者60例,应用随机数字表法分为观察组和对照组,各30例。对照组行经乳晕二氧化碳充气腔镜下甲状腺单侧腺叶+峡部切除术,观察组行经乳晕免充气腔镜下甲状腺单侧腺叶+峡部切除术。比较两组患者麻醉诱导前(T_(1))、腺体切除时(T_(2))、手术结束时(T_(3))、术后第1天(T_(4))及术后第2天(T_(5))细胞免疫相关指标、体液免疫相关指标、炎性反应相关指标,以及T_(1)、T_(2)和T_(3)时点动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))及呼气末二氧化碳(end-tidal carbon dioxide,PetCO_(2))水平。计量资料以x±s表示,两组间比较采用独立样本t检验;组间多时点比较采用双因素方差分析,两两比较采用LSD-t检验;计数资料以例(%)表示,组间比较采用χ2检验。结果在T_(1)时点,两组患者细胞免疫相关指标、体液免疫相关指标和炎性反应相关指标水平比较差异均无统计学意义(均P>0.05)。在T_(2)、T_(3)、T_(4)、T_(5)时点,两组患者血清CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)值和血清免疫球蛋白A、免疫球蛋白M、免疫球蛋白G水平均低于本组T_(1)时点[对照组:(31.49±5.37)%、(26.76±6.11)%、(34.75±5.99)%、(38.92±5.37)%比(51.78±5.90)%,(25.37±8.23)%、(19.12±7.13)%、(29.15±9.85)%、(33.49±8.03)%比(40.12±6.05)%,(0.97±0.28)、(0.71±0.30)、(1.11±0.36)、(1.21±0.39)比(1.69±0.41),(0.95±0.13)、(0.91±0.14)、(0.82±0.13)、(0.96±0.16)g/L比(1.21±0.20)g/L,(7.74±1.26)、(7.33±1.31)、(7.16±1.28)、(7.82±1.31)g/L比(9.18±1.52)g/L,(0.87±0.14)、(0.86±0.13)、(0.73±0.16)、(0.88±0.15)g/L比(1.16±0.22)g/L;观察组:(35.82±5.71)%、(30.85±5.86)%、(39.43±5.68)%、(42.53±5.64)%比(51.36±6.28)%,(30.39±9.76)%、(23.34±8.64)%、Objective To investigate the effect of inflation-free thyroid surgery on patient-specific immune function and inflammatory response.Methods Sixty patients who underwent axillary endoscopic thyroid surgery at the First Affiliated Hospital of Bengbu Medical College from January 2021 to May 2023 were selected and randomly divided into an observation group and a control group using a random number table method,with 30 patients in each group.The control group underwent unilateral lobectomy and isthmus resection under transareola carbon dioxide inflation endoscopy,while the observation group underwent unilateral lobectomy and isthmus resection under transareola non inflation endoscopy.Compare the cellular immune related indicators,humoral immune related indicators,inflammatory response related indicators,as well as arterial blood partial pressure of carbon dioxide(PaCO_(2))and end-expiratory carbon dioxide(PetCO_(2))levels at T_(1),T_(2),and T_(3) time points before anesthesia induction(T_(1)),during adenoidectomy(T_(2)),at the end of surgery(T_(3)),on the first postoperative day(T_(4)),and on the second postoperative day(T_(5))in two groups of patients.The measurement data is represented by x±s,and independent sample t-test is used for comparison between the two groups;The comparison between two groups at multiple time points was conducted using two factor analysis of variance,and the pairwise comparison was conducted using LSD-t test;Counting data is represented as an example(%),and inter group comparisons are made usingχ2 Inspection.Results At time point T_(1),there was no statistically significant difference between the two groups of patients in terms of cellular immune related indicators,humoral immune related indicators,and inflammatory response related indicators(all P>0.05).At time points T_(2),T_(3),T_(4),and T_(5),the CD3^(+),CD4^(+),CD4^(+)/CD8^(+)values and serum IgA,immunoglobulin A,immunoglobulin IgM The levels of immunoglobulin IgG were all lower than the T_(1) time point in this group[control group:(3

关 键 词：腔镜下甲状腺手术 免充气 体液免疫 细胞免疫 炎性反应 

分 类 号：R653[医药卫生—外科学]