胸腔镜与传统开胸手术对肺癌患者T淋巴细胞亚群和NK细胞的影响

目的:比较两种手术方法对肺癌患者免疫功能的影响进而从免疫学角度探讨肺癌胸腔镜手术的临床意义。方法:收集我院胸外科自2016年01月至2016年10月I期或IIa期肺癌患者共60例，随机分为开胸组（TTS组）和胸腔镜组（VATS组）各30例，应用流式细胞仪动态监测两组术前及术后外周血T淋巴细胞亚群和NK细胞水平，比较两组间免疫指标和临床指标。结果:VATS组与TTS组在年龄、性别、病理分期、病理类型、肿瘤最大直径、手术时间及术后拔管时间方面，差异无统计学意义（P>0.05），而在术中出血量、术后下床时间及疼痛评分方面，VATS组明显优于TTS组（P<0.05）。VATS组与TTS组术前1天T淋巴细胞亚群和NK细胞水平差异无统计学意义（P>0.05）。术后第1天TTS组的CD3+T、CD4+T/CD8+T比值、NK细胞较VATS组下降更明显（P<0.05）。术后第3天、第5天，VATS组CD3+T、CD4+T、CD4+T/CD8+T比值，较TTS组上升更明显（P<0.05）。结论:术中出血量、术后下床时间、术后疼痛与肺癌术后免疫功能变化相关，胸腔镜手术比传统开胸手术对机体免疫系统影响更小，且术后免疫功能恢复更好。

The difference between video-assisted thoracoscopic surgery and traditional thoracic surgery on peripheral blood T lymphocyte subsets and NK cells in patients with lung cancer

Objective: To compare the effects of two surgical methods on immune function in patients with lung cancer and to explore the significance of thoracoscopic surgery in the treatment of lung cancer from the perspective of imunology.Methods:Totally 60 patients who suffered from non small-cell lung cancer of I or IIa stage from our hospital thoracic surgery from January to October in 2016，were randomly allocated to traditional thoracic surgery (TTS group) and video-assisted thoracoscopic surgery group (VATS group).The levels of T cell subsets and NK cells in peripheral blood were measured by flow cytometry before operation and after operation，and the immune index and clinical index between the two groups were compared at last.Results:There was no significant difference between VATS group and TTS group in terms of gender，age pathological stage，histological types，maximal tumor diameter，operation times and drainage duration(P>0.05)，but VATS group was significantly better than TTS group in operation blood loss，out-of-bed activity day after operation and pain score.There was no significant difference in T lymphocyte subsets and NK cells levels between VATS group and TTS group before operation(P>0.05).The percentage of CD3+T lymphocytes，CD4+T/CD8+T ratio and NK cells in TTS group were significantly lower than those in VATS group on the first day after operation(P<0.05).The percentage of CD3+T lymphocytes，CD4+T lymphocytes and CD4+T/CD8+T in VATS group were significantly higher than those in TTS group on the 3rd and 5th day after operation(P<0.05).Conclusion:Intraoperative bleeding，get out of bed time，postoperative pain are related to the changes in immune function of lung cancer patients after surgery.Compared to the traditional thoracic surgery，the immune system was less affected and postoperative immune function recovery better in the thoracoscopic surgery.