腹腔镜和开腹结直肠癌手术对机体免疫功能影响的Meta分析

Laparoscopic versus open surgery for colorectal cancer: Meta-analysis for comparing the influence on immune function

目的：比较腹腔镜和开腹结直肠癌手术对机体免疫功能影响。方法：收集1995年1月—2012年12月有关比较腹腔镜和开腹结直肠癌手术对机体免疫功能影响的随机对照研究（RCT）的中英文文献，对相关指标行Meta分析。结果：共纳入13篇RCT文献，共959例患者，其中腹腔镜组465例，开腹组494例。Meta分析结果显示，术后第1～14天，腹腔镜组CD3^＋与CD4^＋T淋巴细胞活性、CD4^＋／CD8^＋比值均高于开腹组（均P〈0．05）；腹腔镜组自然杀伤细胞活性在术后第7天明显高于开腹组（对比时间点为术后第1、3、7天）（P〈0．05）；两组术后第3天的免疫球蛋白（IgA、IgG、IgM）水平比较无统计学差异（均P〉0．05）；腹腔镜组白细胞介素6水平在术后第1天明显低于开腹组（对比时间点为术后第4小时及第1、3、7天）（P〈0．05）；腹腔镜组c反应蛋白水平在术后第1～7天明显低于开腹组（对比时间点为术后第1、3、7、14天）。结论：腹腔镜结直肠癌手术较开腹手术对机体免疫系统影响较小，且能够较好地保留机体免疫系统抵御病原入侵和杀伤肿瘤细胞的功能。

Objective： To compare the impacts between laparoscopic and open surgery on immune function in treatment of colorectal cancer. Methods： Literature of randomized controlled trials （RCT）, published between January 1995 and December 2012 in both Chinese and English, comparing the influences between laparoscopic and open surgery on immune function in treatment of colorectal cancer were collected, and the related parameters were evaluated using Meta- analysis. Results： Thirteen studies involving 959 patients were finally selected, with 465 cases in laparoscopic surgery group and 494 cases in open surgery group. Results of Meta-analysis showed that the activities of CD3^＋ andCD4^＋ T lymphocytes, and CD4^＋/CD8^＋ ratio in laparoscopic surgery group were significantly higher than those in open surgery group on postoperative day （POD） 1 to 7 （all P〈0.05）; the activity of natural killer cells in laparoscopic surgery group was significantly higher than that in open surgery group （time points for comparison were POD 1, 3 and 7） （P〈0.05）; the immune globulin levels （IgA, IgG and IgM） between the two groups on POD 3 showed no significant difference （all P〉0.05）; the interleukin 6 level in laparoscopic surgery group was significantly lower than that in open surgery group on POD 1 （time points for comparison were 4 h after operation, and POD 1, 3 and 7）; the C-reactive protein levels in laparoscopic surgery group were significantly lower than those in open surgery group on POD 1 to 7 （time points for comparison were POD 1, 3, 7 and 14） （all P〈0.05）. Conclusion： Laparoscopic colorectal cancer surgery exerts a less negative influence on the immune system compared with open surger~ and has a better preservation of the immune function that is conducive to preventingpathogenic invasion and killing cancer cells.