比较内镜和传统直肠癌切除术对机体免疫功能的影响

Comparing Effects of Immune Function in Patients Undergoing Endoscopic vs Conventional Resection for Rectal Cancer Under General Anesthesia

目的比较全身麻醉下内镜和传统直肠癌切除术对机体免疫功能的影响。方法30例45～76岁拟行直肠癌切除术的患者,随机将患者分为内镜直肠癌切除术(ESRRC)组和传统直肠癌切除术(ORRC)组,各组各15例。于术前、术后24h、术后72h采集外周静脉血样,采用ELISA法测定IL-6、TNF-α浓度;采用流式细胞仪测定CD3、CD4、CD8表达,计算CD4/CD8;采用免疫比浊法测定血清免疫球蛋白IgG、IgM、IgA、CRP浓度。结果两组患者术后24h血清IL-6明显高于术前(P<0.05),但72h后基本回到术前水平。两组患者围术期各时点PBL亚群均无明显改变,组间各对应时点比较差异亦无统计学意义。术后24h血清IgG均有下降(P<0.01),但ORRC组下降较ESRRC组明显(P<0.05),且持续72h以上。术后48h内,CRP组较术前明显升高(P<0.01),且两组比较ORRC组明显高于ESRRC组(P<0.01)。结论与ORRC相比,ESRRC对机体细胞因子水平及免疫功能的不利影响较小,有利于病人恢复。

Objective To compare the effects of immune function in patients undergoing endoscopic vs conventional resection for rectal cancer under general anesthesia.Methods Thirty patients who received resection for rectal cancer were randomly divided into 2 groups：endoscopic resection for rectal cancer group （ESRRC,n=15） and conventional resection for rectal cancer group （ORRC,n=15）.Venous blood samples were taken before operation,and at 24h and 48h after operation for determination of IL-6 and TNF-α concentrations by ELISA.The expression of CD3,CD4,and CD8 was determined using indirect immunofluorescence,and the ratio of CD4/CD8 was calculated.The concentrations of IgG,IgA,IgM,and CRP were determined by radiommunoassay.Results The concentration of serum IL-6 in both groups were significantly increased after operation （P0.05）,and recovered at 72h after operation.The T cell subsets did not change after operation,but the concentration of serum IgG was significantly decreased after operation,especially in ORRC group （P0.05）.The concentration of serum CRP in both groups were significantly increased in two days after operation （P0.01）,and was significantly higher in ORRC group than in ESRRC group （P0.01）.Conclusions The immune response was less in the patients of ESRRC group than in the patients of ORRC group.It appears that the method of ESRRC is better for the patient’s recovery.