腹腔镜和开腹结直肠癌根治术对患者机体炎症免疫反应的影响

摘要

Objective To investigate the influence of laparoscopic and open radical resection of colorectal cancer on im-muno-inflammatory reactions.Methods 45 cases of colorectal cancer patients were randomly divided into 2 groups.The laparo-scopic group ( 23 cases )received laparoscopic resection of colorectal cancer;the control group (22 cases) received traditional open resection of colorectal cancer.IgA,IgM,IgG,CD3 +,CD4 +,CD8 +,NK cell activity,IL-6,IL-10,TNF–á and CRP were detected and compared 1d before and after the surgery,and 7 d after the surgery.Results 3 d after the surgery,CD3 +,CD8 +, IgA,IgM,IgG decreased in both groups,CRP concentration,TNF,and IL-6-level increased;7 d after operation,CD3 +and CD4 +levels in the laparoscopic group decreased more significantly than those of the control group,and the activity of NK cells had no obvious change.3 d after operation,IgM level in the laparoscopic group was significantly higher than that of the control group;3 d and 7 d after operation, the concentration of CRP in the laparoscopic group were significantly lower than those of the control group,the level of IL-6 in the laparoscopic group was significantly lower than that of the control group,7 d after operation,the con-centration of TNF–á in the laparoscopic group recovered to the preoperative level,postoperative IL-10 level was significantly higher than that of the control group.Conclusion Compared with traditional open operation,laparoscopic resection of colorectal cancer has smaller effect on immune function with lighter inflammatory reactions.%目的：探讨腹腔镜和开腹结直肠癌根治术对患者的机体炎症免疫反应的影响。方法选取45例结直肠癌患者随机分为两组：腹腔镜组和对照组，腹腔镜组23例，在腹腔镜下行结直肠癌根治术；对照组患者22例，采用传统开腹结直肠癌根治术。分别于术前及术后第1 d，术后第7 d测定IgA、IgM、IgG、CD3＋、CD4＋、CD8＋、NK细胞活性、IL-6、IL-10、TNF–á及CRP，并进行对比。结果术后第3 d时，与术前相比两组患者的CD3＋、CD8＋、IgA、IgM、IgG水平均出现降低，CRP浓度、TNF–á和IL-6水平出现上升；术后第7 d，腹腔镜组比对照组患者的CD3＋与CD4＋水平降低更加显著，而NK细胞活性无明显变化。术后第3 d腹腔镜组IgM水平明显高于对照组；术后第3 d和第7 d，腹腔镜组CRP浓度显著低于对照组，腹腔镜组IL-6水平明显低于对照组，此外术后第7 d时腹腔镜组TNF–á浓度恢复至术前水平，腹腔镜组患者术后的IL-10水平显著高于对照组。结论与传统的开腹手术相比，于腹腔镜下进行结直肠癌根治术对于患者的机体的免疫系统的影响相对更小，并且炎症反应更轻。