腹腔镜和开腹直肠癌根治术对机体免疫功能的影响

Influence of laparoscopic and open radical resection of rectal cancer on body immune function

目的探讨腹腔镜下直肠癌根治术(Miles)患者围术期机体免疫功能指标的变化。方法选取2009年8月～2012年12月在本院行结直肠癌根治术的患者80例作为研究对象,随机均分为对照组与观察组各40例,其中对照组患者行传统开腹直肠癌根治术,观察组患者则行腹腔镜下直肠癌根治术;在术前1d和术后第1、2、3天分别抽取两组患者外周静脉血,对辅助性T淋巴细胞(Th)内所包含的Th1与Th2两个亚群的细胞含量、白介素-6(IL-6)、白介素-2(IL-2)以及Th1/Th2含量进行检测。分别在术前1d、术后第3天对CD3+CD56+T细胞进行检测,同时检测CD3-CD56+T自然杀伤细胞(NK)水平。采取酶联免疫吸附法(ELISA)检测IL-2与IL-6的含量;采用流式细胞仪检测CD3+CD56+T细胞及CD3-CD56+NK细胞。结果观察组患者体内Th1含量在术后1d明显高于对照组,组间差异有统计学意义(P<0.05);观察组患者体内Th2含量在术后第1、2、3d均低于对照组,Th1/Th2高于对照组,组间差异具有统计学意义(P<0.05);观察组患者在手术后第2d体内IL-2含量明显高于对照组(P<0.05),同期观察组患者体内IL-6细胞含量则明显低于对照组(P<0.05);在两种不同的术式下,患者体内CD3-CD56+NK与CD3+CD56+T两种细胞所受到的影响差异有统计学意义(P<0.05)。结论行腹腔镜下直肠癌根治术后患者机体出现的免疫功能抑制能够得到一定程度的保护,较好地支持了肿瘤患者的预后。

Objective To explore the changes of perioperative immune function indicators of the patients receiving la- paroscopic radical resection of rectal cancer （Miles）. Methods Eighty patients who received laparoscopic radical resec- tion of rectal cancer in our hospital from August 2009 to December 2012 were selected as the study subjects and ran- domly divided into the control group and the observation group, with 40 patients in each group. The control group re- ceived traditional open radical resection of rectal cancer and the observation group received laparoscopic radical resec- tion of rectal cancer. On the day before surgery and the 1st, 2nd and 3rd day after surgery, the peripheral venous blood of the two groups of patients was extracted for the detection of the cell contents of Thl and Th2 subgroups in- cluded in the helper T lymphocytes （Th）, interleukin-6 （IL-6）, interleukin-2 （IL-2） and Thl/Th2. On the day before surgery and the 3rd day after surgery, the levels of CD3＋CD56＋T cells and CD3-CD56＋T natural killer （NK） cells were de- tected. The enzyme-linked immunosorbent assay （ELISA） was used to detect the contents of IL-2 and IL-6 and the flow cytometry was used to detect the CD3＋CD56＋T cells and CD3-CD56＋T NK cells. Results On the 1st day after surgery, the observation group had significantly higher body Thl content than the control group, with statistically significant dif- ference （P 〈 0.05）; On the 1st, 2rid and 3rd day after surgery, the observation group had higher body Th2 content and higher Th1/Th2 than the control group, with statistically significant differences （P 〈 0.05）; On the 2nd day after surgery, the observation group had significantly higher body IL-2 content than the control group （P 〈 0.05）, but signifi- cantly lower body IL-6 content than the control group （P 〈 0.05）; The influence of different surgical methods on body CD3＋CD56＋T and CD3-CD56＋T NK cells was significantly different, with statistically significance （P 〈 0.05）. Conclusion After the implementation of laparoscopic radical resection of rectal cancer, the body immune function inhibition can be protected to a certain degree, which better support the prognosis of patients with cancer.