腹腔镜和开腹直肠前切除术对机体免疫系统的影响

Influence of laparoscopic and conventional anterior resection for rectum on systemic immune response

目的：比较腹腔镜和开腹直肠前切除术对患者机体免疫应激反应的影响。方法：选择同期腹腔镜和开腹直肠前切除术患者各25例,于术前和术后1、3、5d测定白细胞总数、淋巴细胞总数、CD_4^+、CD_8^+、血清IL-6、IL-8、C反应蛋白、TNF-α。结果：两组手术对术后白细胞总数、淋巴细胞总数、CD_8^+、IL-8、TNF-α的影响差异无显著性(P＞0.05)。腹腔镜组术后CD^(4+)水平高于开腹组(P＜0.05),血清IL-6、C反应蛋白水平明显低于开腹组(P＜0.05)。结论：腹腔镜直肠前切除术和开腹手术相比较对机体全身的免疫功能影响相对较小。

Objective： To compare the influence of laparoscopic and conventional anterior resection for carcinoma of the rectum on systemic immune response. Methods： Patients with a rectosigmoid carcinoma were undergone laparoscopic （n=25） or conventional （n=25） resection. White blood cell counts, total lymphocyte cell counts, CD4^＋ cell, CD8^＋ cell, the proinflammatory cytokines interleukin-6, interleukin-8, C-reactive pro-tein and tumor necrosis factor-alpha were measured preoperatively and on day 1, day 3 and day 5 postoperatively. Results： There was no significant difference in white blood cell counts, total lymphocyte cell counts, CD8^＋ cell, interleukin-8, and tumor necrosis factor-alpha be-tween laparoscopic and open groups. CD4^＋ level after laparoscopic surgery was higher than that after conventional resection group. Serum interleukin-6 and C-reactive protein levels were signifi-cantly lower after laparoscopic surgery than that of the conventional procedure. Conclusion： The systemic immune response after laparoscopic approach is less than that after open approach.