腹腔镜与开腹结直肠癌根治术对机体免疫系统影响的比较研究

Comparison of effects of laparoscopic radical operation and open operation on immune system

目的对比观察腹腔镜手术与传统开腹手术对患者免疫功能的影响。方法 2008年6月～2010年8月收治结直肠癌患者57例。其中行腹腔镜手术27例,开腹手术30例,分别于术前1d、术后第3和7天抽取外周静脉血,用流式细胞仪进行分析检测全血T细胞亚群和NK细胞,采用免疫速率散射比浊法检测血清免疫球蛋白IgA、IgG及IgM的水平。结果术后第3天两组患者外周血CD_3^+、CD_4^+、CD_4^+/CD_8^+及NK细胞活性较术前均明显降低,差异有显著性(P<0.05),但两组间比较差异无显著性(P>0.05);术后第7天,腹腔镜组恢复至接近术前水平(P>0.05),明显高于开腹组,差异有显著性(P<0.05)。两组术后第3、7天免疫球蛋白IgA、IgG及IgM比较差异无显著性(P>0.05)。结论腹腔镜结直肠癌根治术较传统开腹手术对机体免疫机能影响较小,体现了微创优势。

[Objective] To compare the influence of laparoscopic radical operation and open operation on systematic immunity in patients with colorectal carcinoma. [Methods] Fifty-seven patients with colorectal carcinoma from Jun. 2008 to Aug. 2010 were divided into laparoscopic group （n =27） and open abdominal group （n =30）. Peripheral venous blood samples were taken to determine the level of T-cells, NK-cells, and IgA, IgG, IgM on the 1st day before operation, the 3rd and 7th day after operation. [Results] On the 3rd after operation, CD3＋, CD4＋, NK and the ratio of CD4＋/CD8＋ were significantly lower than those on 1st day before operation in two groups （P 0.05）, but there was no statistical difference between the two groups （P 0.05）. CD3＋, CD4＋, NK and the ratio of CD4＋/CD8＋ in the laparoscopic group were significantly higher than those in the open abdominal group on 7th day after operation,and there was statistical difference between two groups （P 0.05）. There was no significantly difference of the level of IgA, IgG, IgM postoperatively between two groups （P 0.05）. [Conclusions] Compared with the radical open operation, the systematic immune response after the laparoscopic radical operation is less, which means the laparoscopic radical operation has predominance in protecting immune system in treating colorectal carcinoma.