早期非小细胞肺癌胸腔镜与开胸肺叶切除术后细胞因子变化的随机对照研究

摘要

Objective To compare video-assisted thoracic surgery (VATS) and open thoracotomy (OT) on acute inflammatory responses and immunosuppression after lobectomy for early non-small cell lung cancer (NSCLC). Methods Present prospective randomized study. OT or VATS lobectomy was performed in patients who met enter criteria and clinical data was collected. Plasma concentration of IL-6, IL-8 and IL10 were measured before surgery and at postoperative day (POD) 1 and POD 3. There were 271 patients underwent lobectomy for early NSCLC, including of 133 patients in group VATS and 138 patients in group OT from January 2007 to June 2008. There were 132 males and 139 females, aging from 19 ～70 years with a mean of ( 56 ± 8) years. Results Compared with OT group, shorter postoperative hospital stay [ ( 8.2 ±2.5) dvs. (9.8±6.2) d, P=0.03], lower morbidity rate (11.3% vs. 21.7%, P=0.02) and lower increase of plasma concentration of IL-6 at POD 1 [ ( 35 ± 25 ) % vs. (65 ± 43 ) %, P = 0.00 ], IL-6 at POD 3 [(14±22)% vs. (55±44)%,P=0.00] and IL-10 at POD 1 [(25 ±20)% vs. (43±35)%, P=0.00] were observed in patients of VATS group. Conclusion VATS lobectomy for early NSCLC is associated with less acute inflammatory responses and less immunosuppression when compared with OT.%目的 比较电视胸腔镜手术(VATS)与开胸手术(OT)肺叶切除术治疗早期非小细胞肺癌(NSCLC)中急性炎症反应和免疫抑制的差异.方法 前瞻性随机对照研究.按照入组标准筛选病例,随机分组后手术,收集临床资料,并检测手术前后IL-6、IL-8和IL-10的血浆浓度.2007年1月至2008年6月最终入选病例271例,其中VATS组133例,OT组138例;男性132例,女性139例;年龄19～70岁,平均(56±8)岁.结果 在术后住院时间[(8.2±2.5)d比(9.8±6.2)d,P=0.03]和术后并发症发生率(11.3%比21.7%,P=0.02)上,VATS组优于OT组.VATS组患者的IL-6血浆浓度在术后第1天[(35±25)%比(65±43)%,P=0.00]、术后第3天[(14±22)%比(55±44)%,P=0.00]以及IL-10血浆浓度在术后第1天的升幅[(25±20)%比(43±35)%,P=0.00]低于OT组.结论 相比于OT,VATS治疗早期NSCLC具有术后炎症反应轻、免疫抑制弱的特点.