非小细胞肺癌患者胸腔镜及传统开胸手术前后甲状腺激素变化的比较

BACKGROUND AND OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) is the representative thoracic minimally invasive surgery. Compared with traditional open surgery (TOS), VATS has an advantage of less invasiveness, quicker recovery and milder postoperative pain. The aim of this study is to compare the influences of VATS and conventional thoracotomic lobectomy on thyroid hormones in treatment for non-small cell lung cancer (NSCLC). METHOD: From Oct. 2010 to Aug. 2012, 44 consecutive patients with NSCLC were recruited and divided into two groups: VATS group (25 patients) and TOS group (19 patients). All the patients were drawn blood to measure the plasma levels of free T3, free T4, reverse T3 and TSH on the morning of the day before surgery, the postoperative day (POD)1, POD2, POD3 and POD7. We described the perioperative variation trend of the thyroid hormones and compared the differences between VATS group and TOS group. RESULTS: There were no differences of thyroid hormone levels between the two groups before surgery. After surgery, the levels of FT3 and TSH were first dropped, then elevated and reached the lowest level on POD3 and POD1 separately. On POD7, they regained the before-surgery levels in VATS group while FT3 level was still significantly lower in TOS group (P=0.032). The FT4 and rT3 levels were first elevated, and then dropped after surgery. They both reached the peak concentrations on POD2, and rT3 levels of TOS group were significantly higher than those of VATS group on POD1, POD2 and POD3 (P < 0.05). The changes of FT3 and rT3 levels were beyond normal ranges while changes of FT4 and TSH levels were within normal ranges. When variation trend of all the thyroid hormones were compared between the two groups, only rT3 level was found to have significant statistical differences (F=7.557, P=0.009). CONCLUSION: All NSCLC patients after lobectomy have Euthyroid sick syndrome (ESS). Compared with traditional thoracotomy, VATS surgery has smaller influence on perioperative thyroid hormones and demonstrates a weaker acute stress reaction, which can benefit postoperative recovery of NSCLC patients.