腹腔镜手术治疗妇科恶性肿瘤对患者腹膜免疫因子的影响

Effects of laparoscopic surgery on peritoneal immune factors in gynecologic malignant tumor patients

目的从腹膜免疫因子变迁探讨腹腔镜手术治疗妇科恶性肿瘤对患者免疫功能的影响。方法选取本院收治的妇科恶性肿瘤患者49例,随机分为腔镜组25例和开腹组24例,腔镜组行腹腔腹微创手术,开腹组行传统开腹术,术后取患者腹膜组织,采用ELISA试剂盒测定免疫因子IL-1、TNF-α和IL-6质量浓度;并分别于术前1 d、术后1 d、术后1周取患者空腹静脉血,采用流式细胞术测定T淋巴细胞亚群T、Th、Ts、Th/Ts及调节性T细胞CD4+CD25highCD127lowTreg水平,衡量患者手术前后的免疫功能状态。结果腹膜组织:腔镜组患者腹膜组织的IL-1、TNF-α和IL-6含量均显著低于开腹组(P<0.05)。外周血:术前1 d,2组患者的T淋巴细胞及调节性T细胞水平无显著差异(P>0.05);术后1 d,腔镜组患者外周血T、Th及Th/Ts水平均显著低于开腹组(P<0.05);CD4+CD25highCD127lowTreg水平显著高于开腹组(P<0.05),2组间Ts水平无显著差异(P>0.05);术后7 d,2组患者的T淋巴细胞及调节性T细胞水平均无显著差异(P>0.05)。结论腹腔镜手术在建立CO2气腹的过程中,可对分泌型免疫因子IL-1、TNF-α和IL-6产生抑制作用,从而削弱患者的免疫功能;然而该抑制作用为短期效应,可随术后时间的延长得以恢复。

It is known that the morbidity rate of gynecologic malignant tumor has been rising for decades.As the development of minimally invasive surgery,laparoscopic cholecystectomy gains a lot in clinical.In this study,we aim to explore the effect of laparoscopic surgery on immune function of gynecologic malignant tumor patients through the perspective of peritoneal immune factors.Total of 49 cases of patients with gynecological malignant tumors were randomly divided into 24 cases of open surgery group（OSG） and 25 cases of laparoscopic surgery group（LSG）.Peritoneal tissues of patients were extracted postoperatively,in which immune factors of IL-1,TNF-α and IL-6 were detected with ELISA kit.Further more,fasting venous blood of patients were respectively extracted to detect T cell subsets＇ cell count before and after surgery.We found that levels of IL-1,TNF-α and IL-6 of patients in LSG were all significantly lower than that in OSG（P 0.05）.Further more,there was no significant difference in T cell subsets count and regulatory T cell count between the two groups before operation（P 0.05）;T,Th and Th/Ts were all significantly lower while CD4＋CD25highCD127lowwas significantly higher in LSG than that in OSG 1 d postoperatively;further more,there was no significant difference in T cell subsets count and regulatory T cell count between the two groups 7 d after operation（P 0.05）.We conclude from the research results that immune function of patient could be weaken in the process of establishing CO2 pneumoperitoneum in laparoscopic surgery through a inhibitive effect on IL-1,TNF-α and IL-6;however,the inhibition is instantaneous which could recover postoperatively.