Effects Of Video-assisted Thoracoscopic Pulmonary Lobectomy On Vital Qi And Immune Function In Patients

Objective:To compare the alterations of systemic immune response and vital qi after video-assisted thoracoscopic surgery and conventional thoracotomy for pulmonary lobectomy.Methods:Sixty patients who were confirmed to be non-small cell lung cancer at stageâ… -â…¡from December 2008 to February 2010 at the Thoracic Surgery department of Fu zhou General Hospital of Nan jing Military Command, were divided into VATS group (31cases) and thoracotomy group (29cases). The patient age, gender, right:left ratio and TNM were equivalent between two groups. All surgeries were completed under the general anesthesia. The operation time, intraoperative blood loss, volume of drain, recovery of out-of-bed ambulation and postoperative hospital stay were compared between two groups. CD3, CD4, CD8, natural killer cells (NK cells) in peripheral venous blood were assayed at time before operation, and 1 day,3 days,5 days after operation.Results:Conventional thoracotomy for pulmonary lobectomy was completed successfully in 29 patients,whereas in VATS group,2cases were converted to open surgery. In VATS group, beside the operation time(P>0.05), intraoperative blood loss, volume of drain, recovery of out-of-bed ambulation and postoperative hospital stay were all better than those in thoracotomy group(P<0.05). There was no difference in all the parameters between the two groups before operation. In VATS group:CD3 and CD4 at 1 day,3 days,5 days after operation were significantly lower than those before operation; CD8 were no statistically difference before and after operation; NK cells at 1 day,3 days,5 days after operation were significantly higher than those before operation; There was no statistically difference in CD4/CD8 before and after operation. In thoracotomy group:CD3 and CD4 at 1 day,3 days,5 days after operation were significantly lower than those before operation; CD8 at 1 day after operation were significantly lower than those before operation; NK cells at 3 days,5 days after operation were significantly higher than those before operation. CD4/CD8 at 1 day after operation were significantly lower than those before operation. CD3, CD4, CD8 and NK cells at 1 day after operationg in VATS group were significantly higher than those in thoracotomy group. There was no statistically difference in CD4/CD8 before and after operation between two groups.Conclusions:Both VATS and thoracotomy for pulmonary lobectomy cause a certain degree of immune suppression and vital qi damage. VATS has less effect on immune function than traditional open surgery. VATS for pulmonary lobectomy is feasible and safe in selected patients with NSCLC at stageâ… -â…¡.