胸腔镜下食管癌手术对术后切口疼痛程度、非特异性和特异性免疫应答的影响

摘要

目的:探讨胸腔镜下食管癌手术对术后切口疼痛程度、非特异性和特异性免疫应答的影响.方法:收集在本院接受手术治疗的食管癌患者56例,回顾其手术方式及相关实验室检查,分为接受胸腔镜手术治疗的胸腔镜组27例、接受传统开胸手术治疗的开放手术组29例.术前、术后1 d,采用散射免疫比浊法检测血清疼痛介质含量,采用流式细胞仪检测非特异性免疫指标、特异性免疫指标水平.结果:术前,两组血清疼痛介质含量以及非特异性免疫应答、特异性免疫应答指标的差异无统计学意义(P>0.05).术后1 d,胸腔镜组血清疼痛介质5-HT、K+、NE的含量低于开放手术组(P<0.05);胸腔镜组外周血非特异性免疫应答指标NK细胞以及C3、C4的含量显著高于开放手术组(P<0.05);胸腔镜组外周血特异性免疫应答指标CD4+、CD4+/CD8+、IgA、IgG的含量显著高于开放手术组(P<0.05).结论:胸腔镜下食管癌手术创伤较小,对免疫应答系统的抑制较轻,是早中期食管癌患者的理想手术方式.%Objective: To explore the effect of thoracoscopic esophagus cancer surgery on postoperative incision pain as well as non-specific and specific immune response.Methods: A total of 56 patients with esophageal cancer who accepted surgical treatment in our hospital between March 2011 and February 2016 were collected, the operation methods and related laboratory tests were reviewed, and then they were divided into the thoracoscope group (n=27) who accepted thoracoscopic surgery and the open surgery group (n=29) who accepted traditional thoracotomy.Before operation and 1 d after operation, immune scatter turbidimetry was used to detect serum levels of pain mediators, and flow cytometer was used to detect the levels of nonspecific immune indexes and specific immune indexes.Results: Before operation, the differences in serum pain mediators as well as nonspecific immune response and specific immune response indexes were not statistically significant between two groups of patients (P>0.05).One day after operation, serum pain mediators 5-HT, K+ and NE levels of thoracoscope group were lower than those of open surgery group (P<0.05);nonspecific immune response indexes NK cell as well as C3 and C4 levels in peripheral blood of thoracoscope group were significantly higher than those of open surgery group (P<0.05);specific immune response indexes CD4+, CD4+/CD8+, IgA and IgG levels in peripheral blood of thoracoscope group were significantly higher than those of open surgery group (P<0.05).Conclusions: Thoracoscopic esophagus cancer surgery causes less damage, has lighter inhibition on the immune response system, and is an ideal operation method for patients with early middle esophagus cancer.