腹腔镜与开腹直肠癌根治术对机体C反应蛋白及体液免疫影响的比较

Effect of laparoscopic-assisted resection of rectal carcinoma on C-reactive protein and humoral immunity

目的探讨腹腔镜直肠癌手术中C反应蛋白（CRP）及免疫功能的变化特点。方法将54例行直肠癌根治术的患者按患者意愿分成腹腔镜组（26例）和开腹组（28例），分别于术前1d和术后1、2、3、7d清晨检测患者静脉血CRP、免疫球蛋白（Ig）：IgG、IgA、IgM及补体C3、C4、CH50水平，比较两组患者手术前后CRP、Ig及补体的变化。结果两组患者CRP术后3d均较术前显著增高（P〈0．01），术后2d达峰值，腹腔镜组术后3d内CRP显著低于开腹组（P〈0．01）。术后两组患者Ig均较术前明显下降，腹腔镜组高于开腹组，但IgG和IgM两组差异无统计学意义（P〉0．05）；而IgA两组差异有统计学意义（P〈0．05）。两组患者术后补体C3、C4及CH50与术前比较差异均有统计学意义（P〈0．05）：腹腔镜组血清补体在术后48～72h已恢复到术前水平，而开腹组在术后72h尚未恢复到术前水平。结论腹腔镜直肠癌根治术和传统的开腹手术均可导致术后机体C反应蛋白浓度增加和免疫水平降低。但腹腔镜手术较开腹手术程度轻。

Objective To investigate the effect of laparoscopic-assisted resection of rectal carcinoma on perioperative levels of C-reactive protein （CRP）, immunoglobulins （Ig） and complements. Methods Fifty-four patients with rectal carcinoma were divided into laparoscopic group （n=26） and open operation group （n=28） according to the patients＇ will. C-reactive protein （CRP）, IgG, IgA, IgM, C3, C4 and CHso of peripheral blood were assayed preoperatively and on the 1st, 2nd, 3rd and 7th day postoperatively. Results Compared with the preoperative period, the CRP levels in both groups were significantly increased on the 1st, 2nd, and 3rd day （P〈0.01） and peaked on the 2nd day postoperatively. The postoperative CRP levels were significantly lower in the laparoscopic group than those in the open operation group （P〈0.01）. After operation, the immunoglobulin levels were significantly decreased in both groups（P〈0.01）, and there were no significant differences in IgG and IgM. The levels of C3, C4 and CH50 were significantly decreased after operation in both groups （P〈0.05） and returned to the preoperative levels during postoperative 48-72 hours in laparoscopic group. Conclusion Laparoscopic-assisted resection of rectal carcinoma results in less wound, lower levels of stress response, and less effect on immune function compared to open surgery, which recovers the immune function of patients more rapidly after operation.