关键词: 剑突, 胸腺扩大切除术；胸腺瘤；炎症因子、T淋巴细胞亚群；应激反应

Abstract: Objective  To analyze the effects of extended subxiphoid thymus resection on inflammatory factors,T lymphocyte subsets and stress response in thymoma patients.Methods  The clinical data of 118 patients with thymoma admitted to our hospital from May 2021 to May 2023 were retrospectively analyzed,of which 61 patients underwent subxiphoid enlargement thymectomy (recorded as the study group) and 57 patients underwent lateral thoracotomy enlargement thymectomy (recorded as the control group).The postoperative and perioperative pain,stress response,inflammatory response,T lymphocyte subsets and complications were compared between the two groups.Results  There was no significant difference in operation time,intraoperative blood loss and postoperative drainage volume between the two groups (P> 0.05).The visual analogue scale (VAS) of the study group (3.21±0.47,2.47±0.34 points) was lower than that of the control group (3.62±0.53,2.61±0.39 points) at 24h and 48h after surgery (P＜0.05).The levels of adrenaline (Adr) and cortisol (Cor) 48h after operation were higher than those before operation (P＜0.05).The levels of Adr and Cor [(101.94±12.83)ng/L,(276.84±31.05)nmol/L] in the study group were lower than those in the control group [(108.15±14.72)ng/L,(308.91±35.24)nmol/L] 48 hours after operation (P＜0.05).The levels of TNF-α and IL-6 48h after surgery were higher than those before surgery (P＜0.05).The levels of tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) in the study group [(40.91±6.93)pg/ml,(55.62±8.67)pg/ml] 48h after surgery were lower than those in the control group [(45.85±8.12)pg/ml,(61.98±10.51)pg/ml] (P＜0.05).The levels of Th1/Th2 and Th17/Treg in both groups 48h after surgery were lower than those before surgery (P＜0.05).The levels of Th1/Th2 and Th17/Treg in the study group (4.75±0.74,0.95±0.17) were lower than those in the control group (5.16±0.89,1.06±0.19) 48h after surgery (P＜0.05).The changes of Th1/Th2 and Th17/Treg in two groups were different (P＜0.05).Conclusion  Compared with lateral thoracotomy,transxiphoid enlargement of thymus can reduce perioperative pain,inhibit perioperative inflammatory response and stress response,improve T lymphocyte subpopulation,and is safe and reliable.

Key words: Excision of xiphoid process,Enlargement of thymus, Thymoma, Inflammatory cytokines,T lymphocyte subsets, Stress response