腹腔镜胃癌根治术对机体全身炎性反应和免疫功能的影响及其临床意义

摘要

目的 分析腹腔镜胃癌根治术对胃癌患者机体全身炎性反应和免疫功能的影响并探讨其临床意义.方法 分别于术前1d,术后1、3和5d在清晨空腹状态下抽取静脉血10 ml,测定白介素6(IL-6)、肿瘤坏死因子(TNF)、C反应蛋白(CRP)、T细胞亚群(CD4+、CD8+、CD4+ CD8+)、NK细胞等指标并进行比较.结果 术前1d腹腔镜组和开腹组间各项指标比较差异均无统计学意义(均P＞0.05).术后1d,两组IL-6、TNF、CRP较术前增高(均P ＜0.05),且腹腔镜组明显低于开腹组(均P＜0.05)；术后5 d IL-6、TNF两组间比效差异均无统计学意义(均P＞0.05),但CRP下降缓慢,两组间比较仍有差异(均P＜0.05)；术后1d两组T细胞亚群(CD4+、CD8+、CD4+CD8+)较术前均降低(均P ＜0.05),而腹腔镜组下降明显低于开腹组(P＜0.05)；术后3d腹腔镜组患者上述指标已恢复至接近术前水平,而开腹组术后3d内持续处于低水平,术后5d还未完全恢复至术前水平.结论 与开腹胃癌根治术相比,腹腔镜胃癌根治术具有机体全身炎性反应轻、保护机体的免疫功能等优势.%Objective To analyze the effects of laparoscopic radical gastrectomy of gastric carcinoma on systemic inflammatory reaction and immune function and its clinical significance. Methods The patients were divided into two groups; the laparoscopic group and the laparotomy group, 20 patients in each group. Venous blood in the empty stomach condition on the morning of the following days was drawn respectively; 1d before surgery, 1d,3d,5d after surgery. Detection indexes such as IL-6, TNF, CRP, CD4+/CD8+cells, CD4+ CD8+ratio, NK cells et al were tested and compared. Results There was no significant difference in every index between two groups on the 1st day before surgery (P >0. 05). On the 1st day after surgery, IL-6, TNF and CRP increased in the two groups apparently ( P < 0. 05) and the indexes in laparoscopic group were less than those in the laparotomy group markedly (P < 0. 05 ). On the 5th day, there was no statistical significance between the two groups any more (P >0.05) , but CRP decreased slowly, still showing the existence of differences to some extent (P <0. 05) ; T-cell subgroups (CD4+/CD8+cells, CD4CD8+ratio) decreased largely (P<0.05) in the two groups on the lst day after surgery, and laparoscopic group decreased less than in the laparotomy group markedly (P <0. 05). A-bove indexes of patients in the laparoscopic group nearly recovered the preoperative level 3 days after sur- gery, but those in the laparotomy group had been keeping a low level for the first 3 days after surgery and they did not recovered fully to the preoperative level on the 5th day. Conclusion Compared with laparotomy radical gastrectomy of gastric carcinoma, laparoscopic radical gastrectomy has the advantages in that it causes slight systemic inflammatory reaction and can protect body immune function.