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目的探讨腹腔镜手术治疗直肠癌对机体全身炎性反应和免疫机能的影响。方法将我院2004年11月～2006年11月收治的直肠癌39例随机分为腹腔镜手术组(19例)和开腹手术组(20例),分别在术前1d和术后1d及5d取外周血,测定白介素(IL)-6、肿瘤坏死因子(TNF)、C反应蛋白(CRP)及CD3+、CD4+、CD8+等各项指标并进行比较。结果开腹组术后第1d,IL-6、TNF及CRP明显高于腹腔镜组(P<0.01);术后第5d,IL-6、TNF两组间差异无统计学意义(P>0.05),但CRP下降缓慢,两组仍有差异(P<0.01)。开腹组术后第1d、5d,CD4+、CD8+细胞均明显低于术前(P<0.01)。而腹腔镜组术后第1d,CD4+、CD8+细胞下降低于开腹组(P<0.01);术后第5d,与术前相比无统计学差异(P>0.05)。结论腹腔镜手术治疗直肠癌的全身炎性反应较开腹手术者轻,且具有保护机体的免疫功能之优势。
Objective To investigate the effect of laparoscopic surgery on systemic inflammatory response and immune function in patients with rectal cancer. Methods Thirty-nine patients with rectal cancer admitted to our hospital from November 2004 to November 2006 were randomly divided into laparoscopic operation group (n = 19) and open operation group (n = 20) Peripheral blood was collected 5 days later to determine the levels of interleukin (IL) -6, tumor necrosis factor (TNF), C-reactive protein (CRP), CD3 +, CD4 + and CD8 +. Results The levels of IL-6, TNF and CRP in the laparotomy group were significantly higher than those in the laparoscopic group on the first postoperative day (P <0.01). There was no significant difference between the two groups on the 5th postoperative day (P> 0.05 ), But CRP decreased slowly, there was still difference between the two groups (P <0.01). The numbers of CD4 + and CD8 + cells in the open group were significantly lower than those before operation (P <0.01) on the 1st day, the 5th day after operation. On the 1st day after operation, the number of CD4 + and CD8 + cells in the laparoscopic group was significantly lower than that in the laparotomy group (P <0.01). There was no significant difference between the laparoscopic group and the preoperation group (P> 0.05). Conclusion Laparoscopic surgery for rectal cancer systemic inflammatory response lighter than open surgery, and has the advantage of protecting the body’s immune function.