Analysis Of Levels Of IgG,IgM,IgA And T-lymphocyte Subsets In Patients With Difference Esophagectomy During Perioperative Period

Objective:Currently,the medical world dispute greatly about perioperative outcomes between open and minimally invasive esophagectomy for esophageal carcinoma,so as to compare surgical outcomes of minimally invasive esophagectomy with open esophagectomy,we selected the immune indices closely related to postoperative complications and prognosis to demonstration.Based on this,the author intends to compare the changes of immune functions and their relationship in surgical patients with esophageal carcinoma after minimally invasive McKeown esophagectomy or open McKeown esophagectomy,and to analysis of levels of IgG,IgM,IgA and T-lymphocyte subsets in patients with difference esophagectomy during perioperative period,and to provides the reference for the surgical method is more suitable for the clinical judgment.Methods:1.Clinical data:A retrospective analysis from March 2015 to February 2017 in patients with esophageal carcinoma in the First Affiliated Hospital of Kunming Medical University.,there are 45 patients met the entry criteria were included in this study.The patients were randomly divided into laparoscopic group(MIME)and conventional group(open McKeown esophagectomy);the laparoscopic group(26 cases)and conventional group(19 cases).There were 34 males and 11 females,with aged from 48 to 75 years old.Among them,5 cases of upper thoracic esophageal carcinoma,16 cases of middle thoracic esophageal carcinoma,24 cases of lower thoracic esophageal carcinoma.All cases had no history of thoracic and abdominal surgery.There was no significant difference in gender,age and tumor location(P>0.05).2.Modus operandi:All patients were treated with intravenous general anesthesia,double lumen endotracheal intubation,and surgical operations were performed by the same group to avoid bias.2.1.Laparoscopic group:The surgical incision was selected by 5 holes in the abdominal cavity and the thoracic cavity with 3 holes.The esophagus was removed with a thoracoscope,and the stomach was separated by laparoscopy,the stoma was located in the neck.(McKeown way).2.2.Conventional group:The patients underwent open McKeown esophagectomy with the three incision including neck plus right chest and in the middle of abdomen,the anastomosis was located in the neck(McKeown way).3.Methods and estimating3.1.Mthods and estimating:T-lymphocyte subsets were detected by flow cytometry,and immunoglobulin was monitored by BN Pro Sper biochemical analyzer.3.2.Lboratory data:The collection,preparation,preservation and monitoring of blood samples were egulated.On day 3 preoperative,and on day 2 and day 7 after operation,,we collected and analyzed the levels of IgG,IgM,IgA and T cell subsets(CD3+,CD4+,CD8+)in all patients.3.3.All observation data was using SPSS 21.0 software package for statistical analysis.Results:1.Humoral immunity:On day 3 preoperative,IgG,IgM and IgA levels in patients of both groups were,respectively,with no statistical difference(P>0.05).On the day 2 after operation,the levels of IgG,IgM and IgA in the two groups were lower than those before surgery(P>0.05),but there was no significant difference between the two groups.On the day 7 after operation,IgG,IgM and IgA levels in patients of both groups were increased,but still lower than the day 2 after operation(P<0.05),and compared with the conventional group,the level of IgG,IgM and IgA in laparoscopic group was significantly higher,the difference was statistically significant(P<0.05).2.Cellular immunity:On day 3 preoperative,CD3+,CD4+,CD8+ and CD4+/CD8+ levels in patients of both groups were,respectively,with no statistical difference(P>0.05).On the day 2 after operation,the levels of CD3+,CD4+ and CD4+/CD8+ in the two groups were lower than those before surgery(P>0.05),but there was no significant difference between the two groups.On the day 7 after operation,the levels of CD3+,CD4+ and CD4+/CD8+ in the laparoscopic group were higher than those in the conventional group(P<0.05).On the day 7 after operation,the conventional group of CD3+,CD4+ and CD4+/CD8+ levels increased slightly than the day 2 after operation(P<0.05),but significantly lower than the day 3 preoperative(P<0.05);The laparoscopic group of CD3+,CD4+,CD4+/CD8+ levels increased gradually,on the day 7 after operation,the levels of CD3+ before and after the operation is no difference statistical significance(P>0.05).Conclusions:1.The experimental results showed that both minimally invasive McKeown esophagectomy and open McKeown esophagectomy,were influence in immunoglobulin content in postoperative patients..2.The experimental results showed that the effects of minimally invasive McKeown esophagectomy in patients with IgM activation of complement and regulation of phagocytosis as well as IgG solid complement and kill the target cells is slightly less than open McKeown esophagectomy.3.The experimental results showed that both minimally invasive McKeown esophagectomy and open McKeown esophagectomy had the inhibited effects in the cellular immunity of the patients,and the concentration of T lymphocyte subsets the decreased in different degree.4.The experimental results showed that the effects of minimally invasive McKeown esophagectomy on the concentration of T lymphocyte subsets in patients was slightly less than that open McKeown esophagectomy.5.The experimental results showed that surgical trauma was related to immune function and postoperative,and it is proved that the minimally invasive surgery,which was represented by minimally invasive McKeown esophagectomy,is less invasive than open McKeown esophagectomy.In clinical effect,especially in the recovery of patients after surgery is superior to open McKeown esophagectomy.