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目的:通过测定因非小细胞肺癌(NSCLC)行完全胸腔镜肺叶切除术或开放肺叶切除术的患者血清中白细胞介素-6(IL-6)、胰岛素样生长因子结合蛋白-3(IGFBP-3)、血管内皮生长因子(VEGF)的含量,比较两种手术方式对NSCLC患者术后免疫功能及预后的影响。方法:选取NSCLC患者40例,分别行完全胸腔镜肺叶切除术(tVATS组)及传统开放肺叶切除术(TOS组),每组20例。采用酶联免疫吸附法测定两组患者术前、术后第1、3、5天外周血中IL-6、IGFBP-3、VEGF的含量,同时收集其他临床资料,并进行比较。结果:行胸腔镜肺叶切除术的患者与行传统开放肺叶切除术的患者相比,术前血清中的IL-6、IGFBP-3、VEGF的含量无统计学差异(P=0.328,0.788,0.458);术后第1、3、5天的IL-6及VEGF水平tVATS组均低于TOS组;IGFBP-3水平术后3个时间点tVATS组均高于TOS组。两组无死亡病例,均未出现术后并发症,tVATS组无中转开胸。两组的手术时间、清扫淋巴结站数及个数、术后引流时间、引流量无显著性差异(P>0.05)。tVATS组的术中失血量、术后疼痛评分、术后下床活动日、术后住院天数明显低于TOS组,有显著性差异(P<0.05)。结论:胸腔镜肺叶切除较开放肺叶切除术对患者手术创伤小、免疫功能影响轻,对于术后肿瘤转移、复发的影响较小,可以改善患者的预后,为后续治疗提供有利条件。
OBJECTIVE: To determine the serum levels of interleukin-6 (IL-6), insulin-like growth factor binding protein-3 (IGFBP-6), interleukin- 3), vascular endothelial growth factor (VEGF) levels in patients with NSCLC were compared between the two surgical methods on immune function and prognosis. Methods: Forty patients with NSCLC were enrolled in this study. Twenty patients in each group underwent complete thoracoscopic lobectomy (tVATS) and conventional open lobectomy (TOS). The levels of IL-6, IGFBP-3 and VEGF in peripheral blood were measured by enzyme-linked immunosorbent assay (ELISA) before and 1, 3 and 5 days after operation. Meanwhile, other clinical data were collected and compared. Results: There was no significant difference in preoperative serum levels of IL-6, IGFBP-3 and VEGF between patients undergoing thoracoscopic lobectomy and conventional open lobectomy (P = 0.328, 0.788, 0.458 ). The levels of IL-6 and VEGF in tVATS group were lower than those in TOS group on the 1st, 3rd and 5th days after operation. The level of IGFBP-3 in tVATS group was higher than that of TOS group at 3 time points after operation. There were no postoperative complications in the two groups with no deaths and no thrombolysis in the tVATS group. There was no significant difference between the two groups in the operation time, the number of lymph node dissection and the number of dissection, the time of drainage and the amount of drainage (P> 0.05). Intraoperative blood loss, postoperative pain scores, postoperative ambulation days, postoperative hospital stay were significantly lower in the tVATS group than in the TOS group (P <0.05). Conclusions: Compared with open lobectomy, thoracoscopic lobectomy is less invasive and has less impact on immune function. It has less effect on postoperative tumor metastasis and recurrence, which can improve the prognosis of patients and provide favorable conditions for follow-up treatment.