腹腔镜与开腹胃癌根治术疗效及对机体免疫功能影响的比较

Comparison of efficacy of laparoscopic versus open radical gastrectomy and impact on immune function

目的探讨腹腔镜与开腹胃癌根治术疗效及对机体免疫功能影响的比较。方法选取2010年10月至2015年10月间德州市齐河县人民医院收治的135例进展期胃癌患者,根据治疗方法不同分为腹腔镜组(68例)与开腹组(67例)。开腹组患者行传统开腹胃癌根治术,腹腔镜组患者行腹腔镜胃癌根治术。观察两组患者临床疗效、术后并发症发生情况、治疗前后外周血免疫细胞、免疫球蛋白、白细胞介素-6(IL-6)、人类白细胞抗原Ⅱ型(HLA-DR)和C反应蛋白(CRP)的变化。结果腹腔镜组患者术中出血量、手术时间、切口长度、排气时间和住院时间均低于开腹组患者,差异均有统计学意义(均P<0.05)。两组患者淋巴结清扫数量比较,差异无统计学意义(P>0.05)。手术后,腹腔镜组患者CD4+和CD4+/CD8+明显高于开腹组患者;腹腔镜组患者术后24h和术后7d的Ig A、Ig G、Ig M和HLA-DR水平均明显高于开腹组患者,IL-6和CRP水平明显低于开腹组患者,差异均有统计学意义(均P<0.05)。开腹组患者并发症发生率为9.0%,腹腔镜组为4.4%,两组患者并发症发生率和CD8+水平比较,差异均无统计学意义(均P>0.05),结论相较于传统开腹手术,腹腔镜手术具有手术时间短、出血量少、创伤小和恢复快等优势,且无明显的免疫抑制作用。

Objective To compare the clinical efficacy of laparoscopic versus open radical gastrectomy and impact on immune function. Methods A total of 135 patients with progressive gastric cancer admitted to Qihe County People＇s Hospital from October 2010 to October 2015 were selected. According to the therapeutic regimen,patients were divided into the laparoscopy group（ 68 patients） and the laparotomy group（ 67 patients）. Laparotomy group was treated with traditional open radical gastrectomy and laparoscopic group underwent minimally invasive laparoscopic radical gastrectomy. Changes in the clinical efficacy,postoperative complications,immunocytes in peripheral blood,immunoglobulins,interleukin-6（ IL-6）,human leukocyte antigen（ HLA） and C-reactive protein（ CRP） were observed in the two groups before and after the treatment. Results The amount of bleeding,operation time,length of incision,exhaust time and length of stay in the laparoscopy group were significantly lower than in the laparotomy group（ P〈0. 05）.There was no significant difference in the number of lymph nodes at lymph node dissection between the two groups（ P〈0. 05）. After the surgery,the level of CD4~＋,CD8~＋and CD4~＋/CD8~＋in laparoscopy group was significantly higher than in the laparoscopy group. Levels of Ig A,Ig G and Ig M were significantly higher in the laparoscopy group than in the laparotomy group,and over the same period,level of HLA-DR was significantly higher and IL-6 and CRP were significantly lower in the laparoscopy group than in the laparotomy group（ all P〈0. 05）. The incidence of postoperative complications was 9. 0% for the laparotomy group and4. 4% for the laparoscopy group. There was no significant difference in the incidence of complications and the level of CD8^＋between the two groups（ all P〈0. 05）. Conclusion Compared with traditional laparotomy,laparoscopic technique has advantages of shorter operation time,less bleeding,less trauma,faster recovery,and no obvious immune suppression,which is suitable for clinical application.