朱秣含

【摘要】 目的：探究胸腔鏡下食管平滑肌瘤摘除术围术期促炎状态及细胞免疫的变化情况。方法：选取2017年2月-2019年12月本院收治的86例食管平滑肌瘤患者，按随机数字表法将其分为对照组和观察组，每组43例。对照组行开胸食管平滑肌瘤摘除术，观察组行胸腔镜下食管平滑肌瘤摘除术。比较两组术前及术后1、3、7 d的血清促炎因子[白细胞介素-1β（IL-1β），白细胞介素-8（IL-8）及肿瘤坏死因子-α（TNF-α）]、炎性应激[超敏C反应蛋白（hs-CRP）、前列腺素E2（PGE2）及铜蓝蛋白（CER）]及细胞免疫（外周血T淋巴细胞亚群）指标。结果：术后1、3、7 d，两组IL-1β、IL-8及TNF-α均先升后降，且观察组均低于对照组（P<0.05）。术后1、3、7 d，两组hs-CRP、PGE2及CER先升后降，且观察组均低于对照组（P<0.05）。术后1、3、7 d，两组CD3+及CD4+呈现先降后升，CD8+先升后降，且观察组均优于对照组（P<0.05）。结论：行胸腔镜下食管平滑肌瘤摘除术治疗的食管平滑肌瘤患者围术期促炎状态及细胞免疫的波动幅度均小于开胸手术，应用价值更高。

【关键词】 胸腔镜食管平滑肌瘤摘除术 围术期 促炎状态 细胞免疫

[Abstract] Objective： To investigate the change situation of proinflammatory state and cellular immunity of patients with thoracoscopic resection of esophageal leiomyoma during the perioperative period. Method： A total of 86 patients with esophageal leiomyoma admitted to our hospital from February 2017 to December 2019 were selected. They were divided into control group and observation group according to random number table method， with 43 cases in each group. The control group was treated with thoracotomy for esophageal leiomyoma， and the observation group was treated with thoracoscopic resection of esophageal leiomyoma. The levels of serum proinflammatory factors [（interleukin-1β （IL-1β）， interleukin-8 （IL-8） and tumor necrosis factor-α （TNF-α）]， inflammatory stress hypersensitive C-reactive protein （hs-CRP）， prostaglandin E2 （PGE2） and ceruloplasmin （CER） and cellular immunity （peripheral blood T lymphocyte subsets） were compared between two groups before and 1， 3 and 7 d after surgery. Result： At 1， 3 and 7 d after surgery， IL-1β， IL-8 and TNF-α in two groups increased first and then decreased， and the observation group were lower than those in the control group （P<0.05）. At 1， 3 and 7 d after surgery， hs-CRP， PGE2 and CER in two groups increased first and then decreased， and the observation group were lower than those in the control group （P<0.05）. At 1， 3 and 7 d after surgery， CD3+ and CD4+ in two groups decreased first and then increased， CD8+ increased first and then decreased， and the observation group were better than those in the control group （P<0.05）. Conclusion： The fluctuation of proinflammatory state and cellular immunity in patients with thoracoscopic resection of esophageal leiomyoma are lower than those of thoracotomy， and the application value is higher.

[Key words] Thoracoscopic resection of esophageal leiomyoma Perioperative period Proinflammatory state Cellular immunity

First-authors address： The Third Peoples Hospital of Yingkou City， Yingkou 115000， China

doi：10.3969/j.issn.1674-4985.2021.09.020

食管平滑肌瘤作为食管良性疾病，对符合手术指征者多主张早期进行手术治疗。而随着胸腔镜等微创手术的发展与完善，其在食管平滑肌瘤患者中的应用率不断提升，其具有创口较小等优势，但是其对患者机体造成的应激反应影响研究欠缺[1-2]。促炎状态及机体免疫应激作为创伤密切相关的方面，其在各类手术患者中的检测价值较高，有助于了解手术创伤所导致的机体应激性变化程度[3]。本研究就胸腔镜下食管平滑肌瘤摘除术围术期促炎状态及细胞免疫的变化情况进行探究与观察，现报道如下。

1 资料与方法

1.1 一般资料 选取2017年2月-2019年12月本院收治的86例食管平滑肌瘤患者。纳入标准：20～65岁;符合手术指征。排除标准：合并创伤;合并感染;合并慢性基础疾病;合并代谢性疾病;处于妊娠期及哺乳期。……