腹腔镜辅助与开腹进展期胃癌根治术对机体免疫功能影响的比较

Clinical comparison of immune response after laparoscope-assisted and open radical operation for advanced gastric cancer

目的:腹腔镜辅助下与开腹行进展期胃癌根治术对机体免疫功能的影响。方法:将94例进展期胃癌患者按意愿分为腹腔镜组(n=47)与开腹组(n=47),测定2组术前及术后第3、7、14天患者血清IL-6、CRP、IgG、IgM、IgA、CD3+、CD4+、CD8+、CD4+/CD8+、人类白细胞抗原II型(HLA-DR)、中性粒细胞(PMN)的数量。结果:2组术后第3天免疫球蛋白较术前均降低(P<0.05),开腹组术后第7天免疫球蛋白较术前低(P<0.05),腹腔镜组术后第7天免疫球蛋白较术前比较差异无统计学意义(P>0.05),除术后第3、7天IgM腹腔镜组高于开腹组(P<0.05),2组间IgA、IgG术后差异无统计学意义(P>0.05);2组术后第3、7天2组IL-6、CRP较术前明显升高(P<0.01),开腹组升高较腹腔镜组更明显(P<0.01);术后第3、7、14天腹腔镜组HLA-DR较术前明显升高(P<0.01),2组间差异有统计学意义(P<0.01,表5);2组术后第3天PMN较术前明显升高(P<0.01);2组外周血CD3+、CD4+、CD4+/CD8+术后第7、14天较术前均明显下降(P<0.01),术后腹腔镜组明显高于开腹组(P<0.01),且腹腔镜组较早恢复正常。结论:与开腹手术相比,腹腔镜手术对机体术后的免疫功能影响小,术后恢复快。

Objective： To compare the changes of immune function after laparoscopic-assisted and open radical gastrectomy for advanced gastric cancer. Methods： Laparoscopic-assisted （n=47）and open（n=47）radical gastrectomy for advanced gastric cancer was performed. IL -6,CRP, IgG ,IgM ,IgA ,CD^3＋,CD^4＋,CD^8＋,CD^4＋/CD^8＋, HLA -DR, PMN were tested before operation and after operation for 3,7 and 14 days. Results： On the day 3 postoperatively, IgG, IgM,IgA significantly decreased as corn oared with those preoperatively in two groups （P〈0.05）. In open group, IgG ,IgM ,IgA decreased as compared to those preoperatively on the day 7 postoperatively（P〈0.05）. In Laparoscope -assisted group, there were significant differences of IgG ,IgM ,tgA between before and after operation （P〉0.05）. The levels of IgA and IgG showed no statistical difference after operation in both groups （P〉0.05）. On the day 3, 7 postoperatively, IL -6 and CRP significantly increased as compared to those preoperatively in two groups （P〈0.01） , and the parameters in Laparoscope-assisted group were all singnificantly high than those in open group （P〈0.01）. In two groups, HLA-DR increased postoperative as compared to preoperatively（P〈0.01）, and there were significant differences of HLA-DR between two groups on the day 3,7 and 14 postoperatively （P〈0.01）, PMN increased after operation 3rd day in two groups（P〈0.01）, On the day 7, 14 postoperatively, the levels of CD^3＋,CD^4＋ and the ratio of CD^4＋/CD^8＋ significantly decreased as compared to those preoper- atively in two groups（P〈0.01 ）, the parameters in Laparoscope- assisted group were all singnificantly high than those in open group （P〈0.01） Conclusion： Laparoscopic-assisted radical gastrectomy resulted in a lesser depression to the immune system and a quicker recovery.