| Objective: Through clinical prospective nonrandomized comparative study, to investigate the differences of immune response and thyroid hormone between anterior chest and breast areola approach endoscopic thyroidectomy and conventional open thyroidectomy. At the same time,we hope the research will provide more theoretical basis for expanding the indication of endoscopic thyroidectomy.Methods: A total of 40 patients were given endoscopic or open thyroidectomy nonrandomly from May 2007 to Jan 2008.Each group contain 20 patients. The endoscopic group is the test group,and the open group is control group. The percentages of T-lymphocytes (CD3+,CD4+,CD8+) and natural killer cells,the levels of immunoglobins (IgG, IgA, and IgM) and the thyroid hormone were detected before and 1d,3d,5d after operation. The white blood cell,neutrophil granulocyte and lymphocyte rate in blood were measured before and 1d,3d after operation.Results: All of the procedures were completed successfully. In endoscopic group, there was no convertion. No hypercapnia, subcutaneous emphysema and anterior chest wall fluidify occurred. No post-operative bleeding, recurrent laryngeal nerve injury, and parathyroid gland injury occurred in both groups. All patients discharged in good health after the pathological report was given.1,No difference was found in gender ratio between two groups (P > 0.05),In endoscopic group, the age of patients was smaller than that in open group (P<0.01) ,the operation time in endoscopic group is short than that in open group (P<0.05) .2,No significant difference in immunity and thyroid hormone was found between two groups before operation (P>0.05) .3,In endoscopic group,the NK cell amount 3 days after surgery was significantly lower than the pre-operative amount (P<0.05),also it was lower than the open group(P<0.05). The NK cell amount 5 days after surgery was significantly lower than the pre-operative amount (P<0.05) in both groups.4,In both groups, the CD3~+ T cell amount 1 days after surgery was lower than the pre-operative amount (P<0.05),also the amount in the open group was even lower than the test group (P<0.05). In control group, the CD3 T cell amount 3 days after surgery was still lower than the pre-operative amount (P<0.05) ,the test group has come to usual.5,In both groups, the CD4~+ T cell amount 1 days after surgery was lower than the pre-operative ammount (P<0.05),also the amount in the open group was even lower than the test group (P<0.05).6,In test group, the CD8~+ T cell amount 3 days after surgery was lower than the pre-operative ammount (P<0.05). In control group, the CD8~+ T cell amount 5 days after surgery was lower than the pre-operative amount (P<0.05).7,In both groups, the ratio of CD4~+/CD8~+ 1 days after surgery was lower than the pre-operative amount (P<0.05).The ratio of CD4~+/CD8~+ 3,5 days after surgery both were turn to usual.8,In both groups, the white blood cell amount 1 days after surgery was more than the pre-operative amount (P<0.05),also the amount in the open group was even higher than the test group (P<0.05).The amount in both groups was decreased 3 days after surgery,the control group was still higher than pre-operative amount (P<0.05),but the test group has come to usual.9,In both groups, the neutrophil cell amount 1 days after surgery was more than the pre-operative amount (P<0.05),also the amount in the open group was even higher than the test group (P<0.05).10,In both groups, the lymphocyte cell amount 1 days after surgery was lower than the pre-operative amount (P<0.05),also the amount in the open group was even lower than the test group (P<0.05). The lymphocyte cell amount 3 days after surgery was still lower than the pre-operative amount in both groups(P<0.05).11,In control group, the level of IgG 5 days after surgery was lower than the pre-operative level(P<0.05). In test group, the level of IgG 1,3,5 days after surgery were lower than the pre-operative level(P<0.05).But there was no difference between the two groups while compare the levels after surgery.12,The level of T3 was lower in the test group than the control group 1day after surgery (P<0.05); In both groups, the level of T4 1 days after surgery was higher than the pre-operative level (P<0.05),the level was more higher 3 days after surgery,it decreased 5 days after surgery,but it was still higher than the pre-operative level(P<0.05); In both groups, the level of FT3 5 days after surgery was higher than the pre-operative level (P< 0.05);In both groups, the level of FT4 1,3,5 days after surgery was higher than the pre-operative level (P<0.05);the level of TSH 1,3,5 days after surgery was lower than the pre-operative level (P<0.05).Conclusion: 1,Endoscopic thyroidectomy via anterior chest and breast areola approach seems to be associated with immune depression,including cell-mediated immunity and humoral immunity during the early time of post-operation.2,Compared with traditional open thyroidectomy,the operation of endoscopic thyroidectomy via anterior chest and breast areola approach has less cell-mediated immunity depression effection,but has no different humoral immunity depression effection during the early time of post-operation.3,The operation of endoscopic thyroidectomy via anterior chest and breast areola approach and the traditional thyroidectomy do the same effect on the human thyroid hormone during the early time of post-operation.
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