直肠癌开腹手术与腹腔镜手术术后免疫功能的研究

Postoperative immune function after laparoscopic or conventional operation in rectal cancer

目的:比较直肠癌开腹手术与腹腔镜手术术后免疫功能的变化。方法:47例没有远处转移的直肠癌分为开腹手术组(22例)和腹腔镜手术组(25例)。术前,术后24、48和72 h测定患者血中白细胞、单核细胞计数,C反应蛋白,白细胞介素6(IL-6),白细胞介素8(IL-8),单核细胞表达的人白细胞DR抗原(HLA-DR),生长激素,催乳素和氢化可的松的水平。结果:腹腔镜手术组术后短期免疫功能得到保存。腹腔镜术后24 h,单核细胞的HLA-DR表达明显升高(75%vs 58%,P=0.024),IL-6水平没有明显升高(4.8 vs 11.5,P=0.002)。开腹和腹腔镜手术患者的白细胞和单核细胞计数、C反应蛋白、IL-8、生长激素、催乳素和氢化可的松水平没有统计学差异。结论:腹腔镜直肠癌术后短期免疫功能得到保存而炎症反应更轻微,说明腹腔镜手术创伤比开腹手术要小,可能有利于抑制术后肿瘤细胞转移。

Objective： To evaluate differences in immunological function following laparoscopic and conventional operation for rectal cancer.Methods： Patients with non-metastasized rectal cancer were prospectively randomized to open（n=22） or laparoscopic（n=25） group.Blood samples were taken preoperatively,24,48,and 72 h following surgery.Systemic white blood cell and monocyte count,C-reactive protein,interleukin-6（IL-6）,interleukin-8（IL-8）,HLA-DR expression on monocytes,growth hormone,prolactin,and cortisol were measured.Results： 47 patients with a median age of 62.5 years were included.22 patients were randomized to open surgery and 25 patients to laparoscopic surgery.Patient demographics in terms of gender,age,BMI,ASA classification,localization of the tumor,operation time,blood loss,and lymph node resection were comparable for both groups.Laparoscopic surgery resulted in a significantly better short-term preservation of postoperative immune function.HLA-DR expression on monocytes was significantly higher（75%vs 58%,P=0.024） and IL-6 level increase was significantly lower（4.8 vs 11.5,P=0.002） 24 h after laparoscopic surgery.No differences between the open and laparoscopic technique were observed in postoperative white blood cell count,monocyte count,C-reactive protein,IL-8,growth hormone,prolactin,and cortisol levels.Conclusion： Short-term postoperative immune and inflammatory functions tended to be better after laparoscopic rectal surgery.Better preserved inflammatory function 24 h after surgery may reflect a reduction in operative trauma and be against spreading malignant cells in the circulation.