全腔镜和腔镜辅助小切口甲状腺手术对机体免疫功能的影响

目的 研究全腔镜和腔镜辅助小切口甲状腺手术对机体免疫功能的影响。方法 选择2013年1月～2015年1月间笔者医院行甲状腺切除手术的患者共100 例，随机分为全腔镜组和腔镜辅助组各50例，观察两组患者手术时间、术中出血量、住院时间、手术费用等手术情况，并且测定两组术前、术后24h外周血淋巴细胞亚群（CD3⁺、CD4⁺、CD8⁺）和免疫球蛋白（IgA、IgG、IgM）水平。结果 全腔镜组手术时间长于腔镜辅助组，术中出血量多于腔镜辅助组，住院天数短于腔镜辅助组，医疗费用多于腔镜辅助组，差异均有统计学意义（P<0.01）；两组患者手术前淋巴细胞亚群（CD3⁺、CD4⁺、CD8⁺、CD4⁺∕CD8⁺）和免疫球蛋白（IgA、IgG、IgM）水平差异均无统计学意义（P>0.05），术后24h，各CD3⁺、CD4⁺、CD8⁺和IgA、IgG、IgM明显下降，CD4⁺/CD8⁺比值明显升高，与术前相比差异有统计学意义（P<0.05），两组术后水平比较差异无统计学意义（P>0.05）。结论 全腔镜和腔镜辅助小切口均可抑制患者的免疫功能，但两种手术方式对机体免疫功能影响不明显。

Impact of Thyroid Surgery with Total Endoscopic Thyroidectomy and Minimally Invasive Video-assisted Thyroidectomy on Immune Function

Objective To compare the impact of endoscopic thyroidectomy and minimally invasive video-assisted thyroidectomy on immune function of the patients. Methods One hundred cases hospitalized in the period from January 2013 to January 2015 to receive thyroidectomy were divided into 2 groups,each 50 cases in endoscope group and endoscope-assisted group comparison in operation time, the total drainage volume,Intraoperative blood loss,hospitalization duration and expenses was made between the 2 groups. Other surgical situation and lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺) and immunoglobulin(IgA,IgG,IgM) preoperative and postoperative 24h between the two groups were determined. Results The operation time in endoscope group was longer than that in endoscope-assisted group and the Intraoperative blood loss volume were bigger than those in endoscope-assisted group. The hospitalization duration and expenses in endoscope group were shorter than those in endoscope-assisted group(P<0.01). CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺,IgA,IgG,IgM levels before surgery in patients between two groups had no statistically significant differences (P>0.05). After 24h, the CD3⁺, CD4⁺, CD8⁺ and IgA, IgG, IgM decreased, CD4⁺/CD8⁺ ratio was significantly increased, and the difference was statistically significant (P<0.05). Postoperative levels between two groups were not statistically significant (P>0.05). Conclusion Both total endoscopic thyroidectomy and minimally invasive video-assisted thyroidectomy inhabit the immune function of the patients. Thyroid surgery with the two approaches is of no significant difference in the impact on immune function.