摘要
目的探讨胸腔镜经剑突下全胸腺切除术和开放手术治疗胸腺瘤疗效比较及对应激反应和免疫功能的影响。方法回顾性分析慈溪市人民医院医疗健康集团2014年1月至2024年10月收治的胸腺瘤患者80例,根据不同手术方式分组,开放组39例行传统开放手术方式治疗,胸腔镜组41例行胸腔镜经剑突下全胸腺切除术。比较两组患者的临床疗效、基本手术情况、并发症发生情况及治疗前后的应激反应和免疫功能标志物。采取例或%表示计数资料,采用χ^(2)检验;使用(±s)表示计量资料,采用t检验,以P<0.05为差异有统计学意义。。结果胸腔镜组患者的治疗总有效率高于开放组(95.00%比77.50%,χ^(2)=5.17,P<0.05),差异有统计学意义。胸腔镜组患者手术时间[(73.10±6.10)min比(96.83±6.81)min,t=16.39,P<0.05]、切口长度[(1.84±0.45)cm比(4.76±1.12)cm,t=15.16,P<0.05]、术中出血量[(30.76±3.16)ml比(48.54±4.48)ml,t=20.42,P<0.05]、住院时间[(5.68±1.05)d比(8.25±1.51)d,t=8.80,P<0.05]均少于开放组,并发症发生率低于开放组(7.50%比27.50%,χ^(2)=5.54,P<0.05),差异有统计学意义。治疗后,胸腔镜组患者5-HT[(124.48±12.14)ng/L比(158.42±10.71)ng/L,t=13.28,P<0.05]、ATCH[(2.12±0.28)ng/ml比(2.93±0.31)ng/ml,t=12.24,P<0.05]、PGE2[(180.17±14.54)pg/ml比(195.11±16.35)pg/ml,t=4.31,P<0.05]、CD8^(+)[(15.34±2.32)%比(22.80±2.95)%,t=12.53,P<0.05]水平均低于开放组,CD3^(+)[(62.32±6.35)%比(34.58±5.76)%,t=20.48,P<0.05]、CD4^(+)[(32.92±3.04)%比(17.10±2.88)%,t=23.90,P<0.05]水平均高于开放组,差异有统计学意义。结论胸腔镜经剑突下全胸腺切除术治疗胸腺瘤疗效优于开放手术,可缩短手术时间,促进患者康复,降低应激反应,提高免疫功能,减少并发症。
Objective To compare the efficacy of subxiphoid video-assisted thoracoscopic total thymectomy and open surgery for thymoma,and to analyze their impacts on stress response and immune function.Methods Retrospective analysis of 80 thymoma patients treated at Cixi People’s Hospital Healthcare Group from January 2014 to October 2024.Patients were divided into two groups according to the surgical approach:the open group(n=39)underwent conventional open surgery,while the thoracoscopic group(n=41)underwent subxiphoid video-assisted thoracoscopic total thymectomy.Clinical efficacy,basic surgical parameters,complication rates,and stress response/immune function markers before and after treatment were compared between groups.Categorical data were expressed as n(%)and analyzed using the chi-square test;Continuous data were expressed as mean±standard deviation(±s)and analyzed using the t-test;A P-value<0.05 was considered statistically significant.Results The thoracoscopic group showed significantly higher total treatment effectiveness than the open group(95.00%vs.77.50%,χ^(2)=5.17,P<0.05).The thoracoscopic group had shorter operation time[(73.10±6.10)min vs.(96.83±6.81)min,t=16.39,P<0.05],smaller incision length[(1.84±0.45)cm vs.(4.76±1.12)cm,t=15.16,P<0.05],less intraoperative blood loss[(30.76±3.16)ml vs.(48.54±4.48)ml,t=20.42,P<0.05],shorter hospital stay[(5.68±1.05)d vs.(8.25±1.51)d,t=8.80,P<0.05],and lower complication rate(7.50%vs.27.50%,χ^(2)=5.54,P<0.05)than the open group.After treatment,the thoracoscopic group demonstrated significantly lower levels of 5-HT[(124.48±12.14)ng/L vs.(158.42±10.71)ng/L,t=13.28,P<0.05],ACTH[(2.12±0.28)ng/ml vs.(2.93±0.31)ng/ml,t=12.24,P<0.05],PGE2[(180.17±14.54)pg/ml vs.(195.11±16.35)pg/ml,t=4.31,P<0.05],and CD8+[(15.34±2.32)%vs.(22.80±2.95)%,t=12.53,P<0.05],while higher levels of CD3+[(62.32±6.35)%vs.(34.58±5.76)%,t=20.48,P<0.05]and CD4+[(32.92±3.04)%vs.(17.10±2.88)%,t=23.90,P<0.05]than the open groupp.Conclusion Subxiphoid video-assisted thoracoscopic total thymectomy demonstrates superior clinical outcomes to open surgery for thymoma treatment,featuring shorter operation time,faster recovery,reduced stress response,enhanced immune function,and fewer complications.
作者
沈立盛
陈坚伟
张燕云
吴丹
Shen Lisheng;Chen Jianwei;Zhang Yanyun;Wu Dan(Department of Surgery,Cixi People’s Hospital Medical and Health Group(Cixi People’s Hospital),Cixi 315300,China;Department of Cardiothoracic&Vascular Surgery,Cixi People’s Hospital Medical and Health Group(Cixi People’s Hospital),Cixi 315300,China;Case Room,Cixi People’s Hospital Medical and Health Group(Cixi People’s Hospital),Cixi 315300,China)
出处
《中华实验外科杂志》
2025年第7期1371-1374,共4页
Chinese Journal of Experimental Surgery
