腹腔镜与开腹宫颈癌根治术对TH1/TH2细胞因子的影响

Comparison of the Effects of Cervical Cancer Radical Laparoscopy and Laparotomy on Th1/Th2 Type Cytokines

目的研究开腹和腹腔镜宫颈癌根治术对机体局部及系统免疫的影响.方法收集昆明医科大学第三附属医院妇科早期(Ⅰa2-Ⅱa1期)宫颈癌患者60例,经腹宫颈癌根治术(abdominal radical hysterectomy,ARH)组、腹腔镜宫颈癌根治术(laparoscopic radical hysterectomy,LRH)组各30例.采用流式细胞术检测患者手术前、术后1 d、术后5 d及术后28 d静脉血及手术中、术后1 d、术后5 d腹腔液中Th1/Th2细胞因子,比较2组手术前后免疫指标的变化.结果腹腔液中Thl/Th2(IFN-γ/IL-4)比值术后第1天2组均较术中其比值下降(P<0.05),术后第5天2组均较第1天回升,但ARH组明显低于术前水平(P<0.05).结论腔镜下宫颈癌根治术对腹膜局部免疫干扰较传统开腹小、恢复快.

Objective To compare the difference of impact on the local and cellular immunity between la-paroscopic and transabdominal radical hysterectomy.Methods Sixty patients with early cervical cancer（Ⅰa2～Ⅱa1）, half of them were assigned to do abdominal radical hysterectomy （ARH ） and the other half for laparo-scopic radical hysterectomy （ LRH ）. Flow cytometry （FCM ） was used to detect Th1 / Th2 cytokines（IL -2,IL-4,IL -6,IL - 10,TNF-a,IFN-r） of peripheral blood before surgery,one day,five days, and 28 daysafter the surgery separately and of peritoneal fluid during surgery,one day, five days after the surgery separately.The changes of immune status was compared.Results The Thl/Th2 （IFN-γ/IL-4 ） ratio in the peritoneal fluidof patients in two groups was lower one day after operation than during the operation （P 〈0.05）,and rised up fivedays after operation, but was significantly lower than the preoperative level in ARH group（ P〈0.05） . Conclu-sions Laparoscopic radical hysterectomy has less effect on the peritoneal local immune function and peritoneal localinflammatory lesions and quicker recovery than the traditional open surgery.