摘要
目的探讨腔镜下免充气甲状腺手术对患者特异性免疫功能和炎性反应的影响。方法本研究为前瞻性病例对照研究。选取蚌埠医学院第一附属医院2021年1月至2023年5月收治的甲状腺结节患者60例,应用随机数字表法分为观察组和对照组,各30例。对照组行经乳晕二氧化碳充气腔镜下甲状腺单侧腺叶+峡部切除术,观察组行经乳晕免充气腔镜下甲状腺单侧腺叶+峡部切除术。比较两组患者麻醉诱导前(T_(1))、腺体切除时(T_(2))、手术结束时(T_(3))、术后第1天(T_(4))及术后第2天(T_(5))细胞免疫相关指标、体液免疫相关指标、炎性反应相关指标,以及T_(1)、T_(2)和T_(3)时点动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))及呼气末二氧化碳(end-tidal carbon dioxide,PetCO_(2))水平。计量资料以x±s表示,两组间比较采用独立样本t检验;组间多时点比较采用双因素方差分析,两两比较采用LSD-t检验;计数资料以例(%)表示,组间比较采用χ2检验。结果在T_(1)时点,两组患者细胞免疫相关指标、体液免疫相关指标和炎性反应相关指标水平比较差异均无统计学意义(均P>0.05)。在T_(2)、T_(3)、T_(4)、T_(5)时点,两组患者血清CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)值和血清免疫球蛋白A、免疫球蛋白M、免疫球蛋白G水平均低于本组T_(1)时点[对照组:(31.49±5.37)%、(26.76±6.11)%、(34.75±5.99)%、(38.92±5.37)%比(51.78±5.90)%,(25.37±8.23)%、(19.12±7.13)%、(29.15±9.85)%、(33.49±8.03)%比(40.12±6.05)%,(0.97±0.28)、(0.71±0.30)、(1.11±0.36)、(1.21±0.39)比(1.69±0.41),(0.95±0.13)、(0.91±0.14)、(0.82±0.13)、(0.96±0.16)g/L比(1.21±0.20)g/L,(7.74±1.26)、(7.33±1.31)、(7.16±1.28)、(7.82±1.31)g/L比(9.18±1.52)g/L,(0.87±0.14)、(0.86±0.13)、(0.73±0.16)、(0.88±0.15)g/L比(1.16±0.22)g/L;观察组:(35.82±5.71)%、(30.85±5.86)%、(39.43±5.68)%、(42.53±5.64)%比(51.36±6.28)%,(30.39±9.76)%、(23.34±8.64)%、(34.68±11.37)%、(38.92±9.82)%比(40.75±5.68)%,(1.15±0.35)、(0.89±0.38)、(1.31±0.33)、(1.52±0.37)比(1.63±0.35),(1.04±0.17)、(0.98±0.10)、(0.91±0.11)、(1.07±0.14)g/L比(1.24±0.18)g/L,(8.51±1.35)、(8.07±1.32)、(7.93±1.34)、(8.56±1.39)g/L比(9.12±1.47)g/L,(0.95±0.11)、(0.93±0.12)、(0.83±0.18)、(0.97±0.14)g/L比(1.19±0.21)g/L],且对照组均低于观察组,两组患者CD8^(+)值均高于本组T_(1)时点,且在T_(4)时点对照组高于观察组[(29.89±8.99)%比(25.70±6.91)%],差异均有统计学意义(均P<0.05)。在T_(2)、T_(3)、T_(4)、T_(5)时点,两组患者血清白细胞介素1β、白细胞介素6、肿瘤坏死因子α和C反应蛋白水平均高于本组T_(1)时点[对照组:(3.92±1.80)、(4.16±1.86)、(5.81±2.14)、(4.46±1.87)ng/L比(1.36±0.61)ng/L,(5.76±2.78)、(6.68±3.12)、(9.73±3.12)、(4.65±2.78)ng/L比(0.92±0.60)ng/L,(1.02±0.42)、(1.30±0.61)、(7.82±2.28)、(6.65±2.16)mg/L比(0.57±0.10)mg/L,(4.48±2.04)、(4.97±2.14)、(6.45±2.52)、(5.33±2.15)ng/L比(2.86±1.03)ng/L;观察组:(3.04±1.09)、(3.29±1.14)、(4.56±2.01)、(3.52±1.34)ng/L比(1.65±0.63)ng/L,(4.12±2.11)、(5.07±2.98)、(8.07±3.15)、(3.22±2.69)ng/L比(0.98±0.53)ng/L,(0.81±0.34)、(1.00±0.50)、(6.65±2.03)、(5.43±1.93)mg/L比(0.56±0.12)mg/L,(3.39±1.81)、(3.84±1.93)、(5.11±2.10)、(3.96±2.03)ng/L比(2.91±1.09)ng/L],且对照组均高于观察组,差异均有统计学意义(均P<0.05)。在T_(1)时点,两组患者PaCO_(2)和PetCO_(2)比较差异均无统计学意义(均P>0.05);在T_(2)、T_(3)时点,对照组PaCO_(2)[(44.1±4.1)、(45.8±4.0)mmHg(1 mmHg=0.133 kPa)]和PetCO_(2)[(40.8±4.0)、(42.1±3.5)mmHg]水平均高于本组T_(1)时点[(38.4±1.8)、(36.3±1.9)mmHg]和观察组同时点[PaCO_(2):(38.3±2.0)、(38.6±2.6)mmHg;PetCO_(2):(36.3±1.9)、(36.5±2.9)mmHg](均P<0.05),而观察组与本组T_(1)时点比较差异均无统计学意义(均P>0.05)。结论免充气腔镜下甲状腺手术相比充气腔镜下甲状腺手术对患者特异性免疫功能的抑制作用较小,且对患者产生的炎性反应较轻。
Objective To investigate the effect of inflation-free thyroid surgery on patient-specific immune function and inflammatory response.Methods Sixty patients who underwent axillary endoscopic thyroid surgery at the First Affiliated Hospital of Bengbu Medical College from January 2021 to May 2023 were selected and randomly divided into an observation group and a control group using a random number table method,with 30 patients in each group.The control group underwent unilateral lobectomy and isthmus resection under transareola carbon dioxide inflation endoscopy,while the observation group underwent unilateral lobectomy and isthmus resection under transareola non inflation endoscopy.Compare the cellular immune related indicators,humoral immune related indicators,inflammatory response related indicators,as well as arterial blood partial pressure of carbon dioxide(PaCO_(2))and end-expiratory carbon dioxide(PetCO_(2))levels at T_(1),T_(2),and T_(3) time points before anesthesia induction(T_(1)),during adenoidectomy(T_(2)),at the end of surgery(T_(3)),on the first postoperative day(T_(4)),and on the second postoperative day(T_(5))in two groups of patients.The measurement data is represented by x±s,and independent sample t-test is used for comparison between the two groups;The comparison between two groups at multiple time points was conducted using two factor analysis of variance,and the pairwise comparison was conducted using LSD-t test;Counting data is represented as an example(%),and inter group comparisons are made usingχ2 Inspection.Results At time point T_(1),there was no statistically significant difference between the two groups of patients in terms of cellular immune related indicators,humoral immune related indicators,and inflammatory response related indicators(all P>0.05).At time points T_(2),T_(3),T_(4),and T_(5),the CD3^(+),CD4^(+),CD4^(+)/CD8^(+)values and serum IgA,immunoglobulin A,immunoglobulin IgM The levels of immunoglobulin IgG were all lower than the T_(1) time point in this group[control group:(31.49±5.37)%,(26.76±6.11)%,(34.75±5.99)%,(38.92±5.37)%,(51.78±5.90)%,(25.37±8.23)%,(19.12±7.13)%,(29.15±9.85)%,(33.49±8.03)%,(40.12±6.05)%,(0.97±0.28),(0.71±0.30),(1.11±0.36),(1.21±0.39)%,(1.69±0.41),(0.95±0.13),(0.91±0.14)(0.82±0.13),(0.96±0.16)g/L vs(1.21±0.20)g/L,(7.74±1.26),(7.33±1.31),(7.16±1.28),(7.82±1.31)g/L vs(9.18±1.52)g/L,(0.87±0.14),(0.86±0.13),(0.73±0.16),(0.88±0.15)g/L vs(1.16±0.22)g/L;Observation group:(35.82±5.71)%,(30.85±5.86)%,(39.43±5.68)%,(42.53±5.64)%vs(51.36±6.28)%,(30.39±9.76)%,(23.34±8.64)%,(34.68±11.37)%,(38.92±9.82)%vs(40.75±5.68)%,(1.15±0.35a),(0.89±0.38),(1.31±0.33),(1.52±0.37)vs(1.63±0.35),(1.04±0.17),(0.98±0.17)0),(0.91±0.11a)(1.07±0.14)g/L vs(1.24±0.18)g/L,(8.51±1.35),(8.07±1.32),(7.93±1.34),(8.56±1.39)g/L vs(9.12±1.47)g/L,(0.95±0.11),(0.93±0.12),(0.83±0.18),(0.97±0.14)g/L vs(1.19±0.21)g/L],The CD8^(+)values of both groups of patients were higher than those of the T_(1) time point in this group,and at the T_(4) time point,the control group was higher than the observation group[(29.89±8.99)%vs(25.70±6.91)%],with statistically significant differences(both P<0.05).At time points T_(2),T_(3),T_(4),and T_(5),both groups of patients had serum IL-interleukin-1 levelsβ、Interleukin IL-6,TNF tumor necrosis factorαThe levels of CRP and CRPC reactive protein were higher than those at T_(1) time point in this group[control group:(3.92±1.80),(4.16±1.86),(5.81±2.14),(4.46±1.87)ng/L vs(1.36±0.61)ng/L,(5.76±2.78),(6.68±3.12),(9.73±3.12),(4.65±2.78)ng/L vs(0.92±0.60)ng/L,(1.02±0.42),(1.30±0.61),(7.82±2.28),(6.65±2.16)mg/L vs(0.57±0.16)mg/L,(4.48±2.04)(4.48±2.04),(6.45±2.52),(5.33±2.15)ng/L vs(2.86±1.03)ng/L;Observation group:(3.04±1.09),(3.29±1.14),(4.56±2.01),(3.52±1.34)ng/L vs(1.65±0.63)ng/L,(4.12±2.11),(5.07±2.98),(8.07±3.15),(3.22±2.69)ng/L vs(0.98±0.53)ng/L,(0.81±0.34),(1.00±0.50),(6.65±2.03),(5.43±1.93)mg/L vs(0.56±0.12)mg/L,(3.39±1.81),(3.89±1.81)4±1.93),(5.11±2.10)(3.96±2.03)ng/L vs(2.91±1.09)ng/L],and the control group was higher than the observation group,with statistically significant differences(all P<0.05).At time point T_(1),there was no statistically significant difference in PaCO_(2) and PetCO_(2) between the two groups of patients(both P>0.05);At time points T_(2) and T_(3),the levels of PaCO_(2)[(44.1±4.1),(45.8±4.0)mmHg]and PetCO_(2)[(40.8±4.0),(42.1±3.5)mmHg]in the control group were higher than those at time points T_(1)[(38.4±1.8),(36.3±1.9)mmHg]and observation group[PaCO_(2):(38.3±2.0),(38.6±2.6)mmHg;PetCO_(2):(36.3±1.9),(36.5±2.9)mmHg](all P<0.05),There was no statistically significant difference between the observation group and this group at T_(1) time point(all P>0.05).Conclusions Inflation-free lumpectomy thyroid surgery is worthwhile as it has less suppressive effect on specific immunity and causes less inflammatory response compared to inflatable lumpectomy thyroid surgery.
作者
杨振
王南海
金功圣
王志
刘梦雅
徐直
Yang Zhen;Wang Nanhai;Jin Gongsheng;Wang Zhi;Liu Mengya;Xu Zhi(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Surgical Oncology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)
出处
《中国综合临床》
2023年第6期459-466,共8页
Clinical Medicine of China
基金
安徽省重点研究与开发计划项目 (202004j07020009)。
关键词
腔镜下甲状腺手术
免充气
体液免疫
细胞免疫
炎性反应
Endoscopic thyroid surgery
Inflation-free
Humoral immunity
Cellular immunity
Inflammatory response
