腹腔镜下结直肠癌手术对机体免疫功能的影响

Immune response of laparoscopic operation in patients with colorectal cancer

目的:探讨腹腔镜和开腹结直肠癌根治术对机体免疫功能的影响。方法:2003年12月至2006年3月,同一手术组将60例结直肠癌患者随机分为腹腔镜组和开腹组,各30例。分别于术前1d和术后第3天、1、2周取外周静脉血,测定C反映蛋白(CRP)、IL-6、免疫球蛋白IgA、Ig M、IgG,CD3+、CD4+、CD8+及NK细胞活性进行比较。结果:术后第3天,两组患者外周血CD3+、CD4+、CD4+/CD8+及NK细胞活性比较无显著性差异(P>0·05),开腹组患者术后第1周、2周显著低于腹腔镜组(P<0·01)。IL-6术后第1、3天,开腹组明显高于腹腔镜组(P<0·01)。CRP术后第3、7天,开腹组明显高于腹腔镜组(P<0·01,P<0·05)。Ig M术后第3天腹腔镜组高于开腹组(P<0·05),IgA,IgG两组间无统计学差异(P>0·05)。结论:腹腔镜结直肠癌根治术比传统开腹手术对机体影响小,在免疫功能保护上更具有优势。

Objective：To compare the alterations of immune function after laparoscopic and open operation in patients with colorectal cancer. Methods：Sixty patients with colorectal cancer were randomly divided into laparoscopic group （ n = 30） and open operation group （ n = 30） from December 2003 to March 2006. C- reactive protein （CRP）, Interleukin-6 （IL-6）,IgA, IgM, IgG, CD3^＋ cells,CD4^＋ cells, CD8^＋ cells, natural killer cell （NK） cells in peripheral blood were assayed at 1 clay before operation, and 3 days, 1 week, 2 weeks after operation. Results： At 3 clays postoperatively, there was no statistical difference in CD3^＋, CD4^＋ , NK and the ratio of CD4^＋/CD8^＋ between the two groups （ P〉0.05）, but the parameters above in open group were all significantly lower than those in tively （ P 〈0.01）. IL-6 at 1, 3 days after operation laparoscope group at 1 week and 2 weeks postoperain open group were significantly higher than those in laparoscope group （ P 〈0.01）. The CRP at 3, 7 days after operation in open group were significantly higher than those in laparoscopic group （ P 〈0.01, P 〈0.05）. The IgM at 3 days after operation in laparoscopic group were significantly higher than those in open group （ P 〈0.05 ）. Conclusion： Laparoscopic operation has less effect on immune function in patients with colorectal cancer than traditional open surgery.