经剑突下胸腺扩大切除术对胸腺瘤病人炎症因子、T淋巴细胞亚群及应激反应的影响  

Effects of transxiphoid enlarged thymus resection on inflammatory factors,T lymphocyte subsets and stress response in thymoma patients

作　　者：冯征 周勇安 张天意 程少毅 尹逊亮 FENG Zheng;ZHOU Yongan;ZHANG Tianyi;CHENG Shaoyi;YIN Xunliang(Department of Thoracic Surgery,Tangdu Hospital,Air Force Military Medical University,Xi’an 710038,China;不详)

机构地区：[1]空军军医大学唐都医院胸外科,西安710038

出　　处：《临床外科杂志》2024年第8期826-829,共4页Journal of Clinical Surgery

基　　金：陕西省重点研发计划项目(S2017-ZDYF-ZDXM-SF-0226)。

摘　　要：目的探讨经剑突下胸腺扩大切除术对胸腺瘤病人炎症因子、T淋巴细胞亚群及应激反应的影响。方法2021年5月~2023年5月我院收治的胸腺瘤病人118例,按手术入路分为两组,研究组61例,采用经剑突下胸腺扩大切除术,对照组57例,采用经侧胸入路胸腺扩大切除术。比较两组病人手术情况及围术期疼痛情况、应激反应、炎症反应、T淋巴细胞亚群和并发症发生情况。结果两组手术时间、术中出血量、术后引流量比较,差异无统计学意义(P>0.05)。研究组术后24小时、48小时的疼痛视觉模拟评分(VAS)分别为(3.21±0.47)分和(2.47±0.34)分,均低于对照组的(3.62±0.53)分和(2.61±0.39)分,差异有统计学意义(P<0.05)。两组术后48小时的肾上腺素(Adr)、皮质醇(Cor)水平均高于术前,差异有统计学意义(P<0.05),研究组术后48小时的Adr、Cor水平分别为(101.94±12.83)ng/L和(276.84±31.05)nmol/L,低于对照组的(108.15±14.72)ng/L和(308.91±35.24)nmol/L,差异有统计学意义(P<0.05)。两组术后48小时的TNF-α、IL-6水平均高于术前(P<0.05),研究组术后48小时的肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6水平分别为(40.91±6.93)pg/ml和(55.62±8.67)pg/ml,均低于对照组的(45.85±8.12)pg/ml和(61.98±10.51)pg/ml,差异有统计学意义(P<0.05)。两组术后48小时的Th1/Th2、Th17/Treg水平均低于术前,差异有统计学意义(P<0.05),研究组术后48小时的Th1/Th2、Th17/Treg水平分别为4.75±0.74和0.95±0.17,均低于对照组的5.16±0.89和1.06±0.19,两组比较差异有统计学意义(P<0.05)。两组总并发症发生率比较差异无统计学意义(P>0.05)。结论与经侧胸入路胸腺扩大切除术相比,经剑突下胸腺扩大切除术可减轻围术期疼痛,抑制围术期炎症反应及应激反应,改善T淋巴细胞亚群。Objective To analyze the effects of extended subxiphoid thymus resection on inflammatory factors,T lymphocyte subsets and stress response in thymoma patients.Methods The clinical data of 118 patients with thymoma admitted to our hospital from May 2021 to May 2023 were retrospectively analyzed,of which 61 patients underwent subxiphoid enlargement thymectomy(recorded as the study group)and 57 patients underwent lateral thoracotomy enlargement thymectomy(recorded as the control group).The postoperative and perioperative pain,stress response,inflammatory response,T lymphocyte subsets and complications were compared between the two groups.Results There was no significant difference in operation time,intraoperative blood loss and postoperative drainage volume between the two groups(P>0.05).The visual analogue scale(VAS)of the study group(3.21±0.47,2.47±0.34 points)was lower than that of the control group(3.62±0.53,2.61±0.39 points)at 24 h and 48 h after surgery(P<0.05).The levels of adrenaline(Adr)and cortisol(Cor)48 h after operation were higher than those before operation(P<0.05).The levels of Adr and Cor[(101.94±12.83)ng/L,(276.84±31.05)nmol/L]in the study group were lower than those in the control group[(108.15±14.72)ng/L,(308.91±35.24)nmol/L]48 hours after operation(P<0.05).The levels of TNF-αand IL-648 h after surgery were higher than those before surgery(P<0.05).The levels of tumor necrosis factorα(TNF-α)and interleukin-6(IL-6)in the study group[(40.91±6.93)pg/ml,(55.62±8.67)pg/ml]48 h after surgery were lower than those in the control group[(45.85±8.12)pg/ml,(61.98±10.51)pg/ml](P<0.05).The levels of Th1/Th2 and Th17/Treg in both groups 48 h after surgery were lower than those before surgery(P<0.05).The levels of Th1/Th2 and Th17/Treg in the study group(4.75±0.74,0.95±0.17)were lower than those in the control group(5.16±0.89,1.06±0.19)48 h after surgery(P<0.05).The changes of Th1/Th2 and Th17/Treg in two groups were different(P<0.05).Conclusion Compared with lateral thoracotomy,transxiphoid en

关 键 词：剑突 胸腺扩大切除术 胸腺瘤 炎症因子、T淋巴细胞亚群 应激反应 

分 类 号：R736.3[医药卫生—肿瘤]