目的:探讨原发性双侧肺癌患者不同病灶的免疫功能及其治疗方式的选择。方法:收集广东祈福医院双侧肺癌患者两次手术切除样本，应用HE染色和肿瘤相关突变基因二代测序技术确定患者双肺肿瘤为原发性双侧肺癌；分别分离左肺和右肺肿瘤切除术时癌巢、癌旁、淋巴结和外周血单个核细胞，流式细胞术检测T细胞和自然杀伤(natural killer，NK)细胞的比例以及颗粒酶B的表达，以此评估两次手术机体免疫状态。结果:病理HE染色和肿瘤突变基因测序确认患者为原发性双侧肺癌。第二次手术时癌巢和癌旁CD3n +T细胞比例为第一次手术时十分之一，且此时病人癌巢、癌旁、淋巴结和外周血中NK细胞表达颗粒酶B的表达明显降低。n 结论:肺肿瘤切除术对患者免疫状态的影响极大，第二次手术时患者免疫细胞数目和功能都大大降低，不利于机体术后恢复和清除肿瘤。对于原发性双侧肺癌患者，在患者身体条件耐受的前提下，更建议一次手术完成双侧原发肿瘤的切除。“,”Objective:To explore the immune function of different lesions of primary bilateral lung cancer and the choice of therapy methods.Methods:Samples from patient with bilateral lung cancer in Clifford Hospital were collected.HE staining and second-generation sequencing technology for tumor-related mutation gene were used to determine whether the lung tumors were primary bilateral lung cancers; Mononuclear cells from tumor nests, pericarcinomatous tissues, lymph nodes and peripheral blood during tumor resection of the left and right lungs were separated respectively. Flow cytometry was used to detect the ratio of T cells and natural killer(NK) cells and the expression of Granzyme B to evaluate the immune functions of the body during the two operations.Results:The results of pathological HE staining and next-generation sequencing technology for tumor mutation gene sequencing confirmed that the patient was primary bilateral lung cancer. During the second operation, the ratio of CD3n + T cells in cancer nests and pericarcinomatous tissues was greatly reduced, which was only one-tenth of the first operation. In addition, the expression of Granzyme B on NK cells in the patient\'s cancer nest, pericarcinomatous tissues, lymph nodes and peripheral blood was significantly reduced.n Conclusion:Lung tumor resection greatly affected the patient\'s immune function, and the proportion and function of immune cells were significantly reduced during the second operation, which was not beneficial for postoperative recovery and tumor clearance. For patients with primary bilateral lung cancer, it was recommended to complete the resection of both primary tumors in one operation if the patient’s physical condition could tolerate it.