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目的探讨胸腔镜微创与开胸两种手术方式对胸腺瘤合并重症肌无力患者炎性反应的影响。方法纳入2014年8月至2015年6月接受手术治疗的MasaokaⅠ期或Ⅱ期的胸腺瘤合并重症肌无力患者,胸腔镜手术治疗组与传统开胸手术治疗组各20例。于麻醉前(T1)、麻醉后(T2)、切皮后2 h(T3)、术后24 h(T4)、术后48 h(T5)和术后72 h(T6)6个时间点取外周静脉血,应用酶联免疫试剂盒(ELISA)检测IL-6、IL-8、TNF-α、CRP、CORT的浓度。记录患者围手术期一般临床资料。采用SPSS 17.0软件对数据进行统计分析。结果胸腔镜组和传统开胸组各相邻时间点炎性因子比较:IL-6、IL-8、TNF-α、CRP和CORT的表达水平在T1、T2和T3三个时间点比较差异无统计学意义(P值均>0.05);术后各因子水平比术前明显升高,T4时间点达到峰值(P值均<0.01),而后逐渐下降。T6时间点除胸腔镜组TNF-α恢复至术前水平(P>0.05)外,胸腔镜组和传统开胸组其它各因子仍高于术前水平(P值均<0.01)。胸腔镜组各因子在T4、T5和T6时间点明显低于传统开胸组(P值均<0.05)。胸腔镜组手术时间、术后引流管留置时间、切口愈合时间明显少于开胸组(P值均<0.05)。结论胸腔镜下胸腺瘤根治术可减少患者手术创伤,减轻炎性反应程度,具有较好的临床推广价值。
Objective To investigate the effects of thoracoscope minimally invasive and thoracotomy on the inflammatory response in patients with thymoma and myasthenia gravis. Methods A total of 20 patients with mastectomy stage I or II thymoma with myasthenia gravis undergoing surgery between August 2014 and June 2015 were enrolled in this study. Thoracoscopic surgery group and conventional thoracotomy group were treated with 20 cases. At 6 time points before anesthesia (T1), after anesthesia (T2), 2 h after transection (T3), 24 h after operation (T4), 48 h after operation (T5) and 72 h Peripheral venous blood was collected. The concentrations of IL-6, IL-8, TNF-α, CRP and CORT were detected by enzyme linked immunosorbent assay (ELISA). Perioperative records of patients with general clinical data. The data were analyzed by SPSS 17.0 software. Results The expression of IL-6, IL-8, TNF-α, CRP and CORT at adjacent time points in thoracoscopic group and conventional thoracotomy group were not significantly different at T1, T2 and T3 Statistical significance (P> 0.05). The postoperative levels of various factors were significantly higher than those before operation, reaching the peak at T4 (P <0.01), and then decreased gradually. Thoracic group and conventional thoracotomy group were all higher than the preoperative level (P <0.01), except T-6 in thoracoscope group returned to preoperative level (P> 0.05). The factors of thoracoscopic group at T4, T5 and T6 time points were significantly lower than the conventional thoracotomy group (P <0.05). Thoracoscopic surgery time, postoperative drainage tube indwelling time, incision healing time was significantly less than the thoracic group (P value <0.05). Conclusion Thoracoscopic thymoma radical surgery can reduce the surgical trauma patients, reduce the degree of inflammatory response, has a good clinical value.