腹腔镜辅助下胃癌根治术对机体免疫功能的影响

Immune response to laparoscopic-assisted radical gastrectomy

目的 比较腹腔镜和开腹胃癌根治术对机体免疫功能的影响。方法 将42例胃癌根治术患者分为腹腔镜组(n =2 2 )和开腹组(n =2 0 ) ,于术前1天和术后第2天、1、2周采用流式细胞仪检测胃癌患者外周血CD3 + 、CD4+ 、CD8+ 及NK细胞活性。结果 术后第2天,两组患者外周血CD3 + 、CD4+ 、CD4+ /CD8+ 及NK细胞活性较术前均显著降低(P <0 0 5 ) ,但两组之间比较无显著性差异(P >0 0 5 )。腹腔镜组患者术后1周上述指标迅速恢复至接近术前水平,而开腹组术后1周内持续处于低水平,术后2周才恢复至接近术前水平。开腹组患者上述指标术后1、2周均显著低于腹腔镜组(P<0 0 5 )。结论 腹腔镜辅助下胃癌根治术对机体免疫功能影响小,且恢复较开腹手术快。

Objective To compare the changes of immune function after laparoscopic-assisted (LARG) and open radical gastrectomy (ORG) for gastric cancer. Methods Laparoscopic-assisted (n=22) and open (n=20) radical gastrectomy for gastric cancer was performed. Flow cytometry was used to detect the phenotypes of T lymphocyte subsets and NK cells in blood samples from gastric cancer patients at day 1 preoperatively and day 2, week 1, week 2 postoperatively. Results On day 2 postoperatively, CD3 +, CD4 +, NK and the ratio of CD4 +/CD8 +significantly decreased as compared to those preoperatively in two groups (P<0.05), but there was no statistical difference between two groups (P>0.05). CD3 +, CD4 +, NK and the ratio of CD4 +/CD8 + recovered rapidly in laparoscoptic-assisted group at week 1 postoperatively, but they kept continuously low in 1 week and recovered at week 2 postoperatively in open group. The parameters above in open group were all significantly lower than those in laparoscope-assisted group at week 1 and 2 postoperatively (P<0.05). Conclusion Laparoscopic-assisted radical gastrectomy brings up a lesser depression to the immune system and a quicker recovery.