结直肠癌腹腔镜围手术期机体免疫生理变化研究

目的探讨结直肠癌腹腔镜围手术期机体免疫生理变化。方法 86例拟行结直肠癌手术的患者分为传统开腹组46例和腔镜组40例。分别于术前及术后第1d、第3d、第8d抽取患者外周静脉血检测C反应蛋白（CRP）,免疫球蛋白LgA、LgM、LgG,CD4＋,CD8＋,胃动素（MTL）,胃泌素（GAS）,白介素-6（IL-6）。结果开腹组胃动素术后明显低于腔镜组（P〈0.05）。胃泌素两组术后明显升高（P〈0.05）,同时期两组间无明显差异（P〉0.05）。腔镜组CD8＋术后第8d与同期开腹组差异有统计学意义（P〈0.05）。两组患者术后LgA、LgM、LgG含量较术前明显下降（P〈0.05）。两组患者术后CRP含量明显增高（P〈0.05）。两组患者IL-6术后明显高于术前水平（P〈0.01）,术后第8d腔镜组IL-6降至术前水平,开腹组仍高于术前,且同期差异有统计学意义（P〈0.05）。结论腹腔镜结直肠癌手术对患者术后免疫功能和生理反应的抑制有一定的保护作用,相比传统开腹手术在免疫功能和生理反应上具有更大的优势。

Changes of physiological function of the immune in patients undergoing laparoscopy-assisted colorectal tumor surgery during peri-operation period

Objective To investigate the changes of physiological function of the immune in patients undergoing laparoscopy-assisted colorectal tumor surgery during peri-operation period.Methods 86 patients with colorectal tumor undergoing elective surgery were assigned to laparoscopy-assisted group with 40 cases and conventional open abdominal group with 46 cases.Peripheral venous blood samples were taken to determine the level of CRP,LgA,LgM,LgG,CD4+,CD8+,MTL,GAS,IL-6 at pre-operation and post-operation1,3,8d,respectively.Results The level of MTL in open abdominal group was lower than that of laparoscopy-assisted group at post-operation(P<0.05).The level of GAS of the two groups at post-operation was higher than that at pre-operation(P<0.05),while there was no significant difference between the two groups at the same period(P>0.05).The difference of CD8+ between the two groups at the post-operation 8d was significantly(P<0.05).Compared with the level of LgA,LgM,LgG at pre-operation,that at post-operation decreased significantly in both groups(P<0.05).Postoperative CRP levels were significantly higher(P<0.05).The level of IL-6 at the post-operation was significantly higher than that at the pre-operation(P<0.01).At the post-operation 8d,the level of IL-6 decreased as that at the pre-operation of the laparoscopy-assisted group,but it was still higher than that at the pre-operation of the open abdominal group,and the difference between the two groups was statistically significant at the same period(P<0.05).Conclusion The immune function and physiological function in patients with laparoscopy-assisted colorectal cancer surgery can be partly preserved during postoperative period.Compared to conventional open abdominal surgery,laparoscopy-assisted colorectal cancer surgery has greater advantages in the immune function and physiological responses.