葡萄球菌肠毒素A对肝癌肿瘤浸润淋巴细胞抗瘤活性的作用

目的探讨葡萄球菌肠毒素A(SEA)对肝癌肿瘤浸润淋巴细胞(TIL)抗瘤活性的诱导作用。方法取5例手术切除肝癌标本,分离TIL,在SEA作用下进行培养。定时记数,了解其增殖情况。流式细胞仪检测其CD3、CD4、CD8表达情况,噻唑蓝(MTT)比色法测定其对HepG-2肝癌细胞株的细胞毒活性,酶联免疫吸附试验(ELISA)测定培养上清液中肿瘤坏死因子(TNF)-α和γ-干扰素(IFN-γ)浓度。结果在SEA刺激下,2周TIL扩增100倍。1周后CD3+细胞占95%以上,CD8+细胞较CD4+细胞增殖更迅速。TIL细胞毒活性随培养逐渐增强。在培养的前10d内,TIL产生大量的TNF-α峰值达(453.70±9.26)ng/L和IFN-γ,其峰值达(2013.22±20.41)ng/L。结论SEA可高效、迅速诱导肝癌TIL的抗瘤活性。     

测定CD3 8+ CD8+ T淋巴细胞在监测肾移植后巨细胞病毒感染中的作用

目的观察CD38+CD8+T淋巴细胞水平在肾移植后巨细胞病毒感染患者体内的变化,探讨其监测肾移植后巨细胞病毒活动性感染的可能性.方法分别应用流式细胞术和免疫组织化学方法测定56例肾移植受者手术前后的CD38+CD8+T淋巴细胞水平和巨细胞病毒白细胞抗原,并将两者结果进行比较.结果肾移植术前所有患者巨细胞病毒白细胞抗原均为阴性,其(CD38+CD8+)/CD8+的平均比值为0.11±0.05;肾移植后检测到有14例患者巨细胞病毒白细胞抗原阳性,出现阳性的时间为术后(32.7±16.6)d,(CD38+CD8+)/CD8+的比值在术后(29.6±8.4)d出现了有显著意义的升高,平均数值为0.43±0.21.这些患者接受静脉滴注丙氧鸟苷治疗后巨细胞病毒白细胞抗原转阴,(CD38+CD8+)/CD8+平均比值下降为0.16±0.09.治疗前后CD38+CD8+T淋巴细胞水平比较差异有显著性意义(P＜0.05).结论CD38+CD8+T淋巴细胞水平的检测结合巨细胞病毒白细胞抗原检查有助临床监测肾移植后CMV活动性感染.     

腹腔镜可调节捆扎带胃减容术对病态肥胖患者免疫功能的影响

目的比较病态肥胖症(MO)患者行腹腔镜可调节捆扎带胃减容术(LAGB)手术前后的免疫功能。方法MO组15例,平均体重指数(BMI)358kg/m2,于2003年6月2003年10月行LAGB,监测手术后体重变化。并于术前、术后1、3、6个月测定外周血T淋巴细胞总数(TLC)、T细胞亚群(CD+3、CD+4、CD+8、CD+4/CD+8)、自然杀伤细胞(NKC)百分比、血浆白细胞介素2(IL2)、白细胞介素6(IL6)浓度等免疫指标。对照组15例,平均BMI236kg/m2,入院时检测上述指标。应用SPSS110统计分析软件对各组数据进行统计学分析。结果MO组与对照组相比,术前CD+4、CD+4/CD+8显著降低(P<001),血浆IL2、IL6浓度显著升高(P<001)。LAGB术后6月体重、BMI、腰围及臀围均明显下降(P<001)。与术前相比,MO组术后6个月CD+4、CD+4/CD+8明显升高(P<005),但仍低于对照组(P<001);IL2、IL6浓度明显降低(P<001,P<005)。结论MO患者合并免疫功能异常,LAGB术后体重减轻后,免疫功能可部分改善。     

腹腔镜与开腹子宫切除术对免疫功能影响的比较

目的比较腹腔镜与开腹子宫切除术对机体免疫功能的影响。方法选择44例有子宫切除指征的患者,分为2组:腹腔镜治疗25例(腹腔镜组),接受开放手术19例(开腹组)。比较两组的手术时间、术中出血量、术后镇痛用药、术后住院时间情况;并采用散射比浊法测定免疫球蛋白IgG、IgM、IgA,补体C3、C4水平,采用流式细胞仪测定CD3+(T细胞总数)、CD4+(T辅助/诱导细胞)、CD8+(T抑制/杀伤细胞)的数量,进行组间比较。结果两组手术时间(100.5±15.9 m invs 97.0±17.9 m in)无显著性差异(t=0.685,P=0.497),腹腔镜组术中出血量(65.0±48.9 m l vs 150.0±100.4 m l)、术后镇痛率(3/25 vs 16/19)及术后住院时间(5.4±1.3 d vs 7.4±1.5 d)明显小于开腹组(t=-3.703,2χ=22.943,t=-4.730;P=0.000)。两组IgM、IgA、C4手术前后均无明显变化,两组间亦无显著差异。腹腔镜组术后1 d IgG较术前有所下降,术后3 d恢复至术前水平,C3无明显变化;开腹组IgG、C3术后1 d明显低于术前水平,术后3 d恢复到术前水平。两组比较,开腹组术后1 d IgG、C3下降明显。腹腔镜组T淋巴细胞亚群手术前后均无显著性差异。开腹组术后1、3 d CD3+、CD4+、CD8+与术前比较均明显降低,术后5 d恢复至术前水平;两组比较,术后1、3 d开腹组CD3+、CD4+、CD8+均明显低于腹腔镜组。结论腹腔镜对机体免疫功能的影响小,为术后恢复较快提供了病理生理学依据。     

原发性肝癌患者体内的CD4+CD25+ T细胞变化及其意义

目的:探讨原发性肝细胞癌(HCC)患者体内CD4+CD25+T细胞变化的及其意义。 方法:实验分HCC组（n=20）与正常人对照组(n=10)，采用免疫荧光标记法，流式细胞仪分离出外周血CD4+CD25+T细胞，分析两组CD4+CD25+T细胞所占T细胞的比例。计算并比较癌组织与癌旁组织中CD4+CD25+T细胞所占T细胞的比例。结果:HCC组机体的CD4+CD25+T 细胞比例为(19.3±3.0) %，明显高于对照组(5.2±1.6) % (P<0.05)。癌组织中CD4+CD25+T 细胞比例为(6.5±2.9) %，癌旁组织中CD4+CD25+T 细胞比例为(5.8 ±2.1) %， (P>0.05)。结论:原发性肝细胞癌患者机体免疫功能降低的原因之一可能是外周血CD4+CD25+T 细胞数明显增加。     

腹腔镜与开腹结直肠癌手术对机体免疫功能的比较

为比较腹腔镜和开腹结直肠癌根治术对机体免疫功能的影响，笔者将2年间收治的60 例结直肠癌患者随机分为腹腔镜组和开腹组，各30例 。由同一手术组对60例患者实施手术。分别于术前1d的和术后第3天及第1，2 周取外周静脉血，测定C反应蛋白（CRP），IL-6，免疫球蛋白IgA，IgM，IgG， CD3+ ，CD4+，CD8+及NK细胞活性;对两组细胞活性进行比较。结果示，术后第3 天,两组患者外周血CD3+ ，CD4 +，CD4+/ CD8+及NK 细胞活性差异无显著性 (P>0.05) ;但于术后第1，2 周开腹组显著低于腹腔镜组 (P<0.01) 。术后第3 天，开腹组IL-6明显高于腹腔镜组（P<0.01）。术后第3，7d，开腹组CRP明显高于腹腔镜组（P<0.01，P<0.05）。术后第3天腹腔镜组IgM高于开腹组（P<0.05）;IgA,IgG两组间无统计学差异（P>0.05）。提示腹腔镜结直肠癌根治术比传统开腹手术对机体影响小，对保护患者免疫功能具有优势。     

CD4+CD25+调节性T细胞、Foxp3 mRNA及可溶性白细胞介素2受体检测在肾移植中的意义

目的 观察肾移植患者外周血中CD4+CD25+调节性T细胞水平及其表面特异性标志物Foxp3和可溶性白细胞介素2受体（sIL-2R）的变化，探讨其在诊断移植肾急性排斥反应中的作用和价值。 方法 选取42例维持性血液透析接受同种异体肾移植治疗的患者及30例健康体检对照者。在患者移植前、移植后1、2、4、8周或发生排斥反应时，以流式细胞仪检测外周血中CD4+CD25+调节性T细胞水平；荧光定量PCR检测Foxp3 mRNA表达；双抗体夹心酶联免疫吸附法（ELISB）检测血浆中sIL-2R水平。 结果 (1)移植后第1、2、4、8周急性排斥反应组CD4+CD25+调节性T细胞、Foxp3 mRNA水平明显低于同期未发生排斥的肾功能稳定组，而sIL-2R水平却显著高于肾功能稳定组。(2)血液透析患者外周血CD4+CD25+调节性T细胞[(9.22±3.53)%]、Foxp3 mRNA[（0.82±0.36）×10-3]及sIL-2R[（856.30±108.24） U/ml]水平与健康对照组[分别为(6.09±1.99)%、(0.50±0.28)×10-3、(247.35±11.24) U/ml]比较，差异均有统计学意义(P < 0.01)。(3)肾移植后随着肾功能的恢复，外周血CD4+CD25+调节性T细胞[(16.53±4.14)%]、Foxp3 mRNA[(4.97±1.94)×10-3]显著升高(P < 0.01)，而sIL-2R[（463.72±31.23）U/ml]水平明显降低(P < 0.01)。(4)当发生急性排斥反应时，CD4+CD25+调节性T细胞[(12.18±2.86)%]、Foxp3 mRNA[(3.15±1.22)×10-3]显著降低(P < 0.01)，而sIL-2R[(748.36±115.41) U/ml]水平明显升高(P < 0.01)，并且这些变化早于Scr的变化。(5)患者移植前后外周血CD4+CD25+调节性T细胞百分率与Foxp3 mRNA水平均呈正相关（分别为r ＝ 0.904、0.932，P < 0.01），但与sIL-2R水平无相关。 结论 外周血CD4+CD25+调节性T细胞、Foxp3 mRNA及sIL-2R水平的测定均可以作为肾移植患者移植后发生急性排斥反应的早期预测指标，并可判断预后。     

后腹腔镜输尿管切开取石术对机体免疫功能的影响

目的:研究后腹腔镜输尿管切开取石术对机体免疫功能的影响。方法:60例输尿管切开取石术患者随机分为后腹腔镜组(30例)和传统开放手术组(30例),患者术前、手术开始后2h、术后1d、术后2d、术后8d抽取静脉血8ml,T细胞亚群CD4、CD8应用Elite-ESP型流式细胞仪进行分析检测,血清免疫球蛋白IgA、IgG、IgM水平采用免疫速率散射比浊法检测。结果:本研究提示腹腔镜组CD4、CD8手术后下降程度较小,且恢复较快,术后8d均恢复至术前水平。开放手术组术后CD4、CD8下降程度较大,恢复较慢,术后8d仍较术前和腹腔镜组低(P0.05)。腹腔镜组IgA、IgG、IgM术后各个时间节点较术前均无差异(P0.05)。开放手术组IgM术后各个时间节点较术前均无差异;IgG术后1d开始下降,术后8d仍未恢复;IgA术后下降较迟,术后8d开始低于术前水平(P0.05)。结论:后腹腔镜输尿管切开取石术与开放手术比较,其对机体细胞免疫和体液免疫功能影响较小,体现了微创优势。     

复方甘草酸苷辅助治疗对艾滋病患者T细胞亚群的影响

目的:探讨复方甘草酸苷辅助治疗艾滋病的疗效和机制。方法:40例艾滋病患者随机分为两组,对照组(n=20)予高效抗逆转录病毒治疗(HAART),治疗组(n=20)在HAART基础上,另加用复方甘草酸苷治疗,疗程6个月。观察治疗前后CD4+T细胞计数、外周血淋巴细胞表面CD38、HLA-DR的表达。结果:治疗6个月后,治疗组CD8+CD38+T细胞[(6.6±2.1)%]下降较对照组[(11.4±3.8)%]更明显(t=5.043,P<0.01),CD4+T细胞计数[(243.6±91.2)×106/L]升高比对照组[(170.8±55.7)×106/L]更显著(t=3.045,P<0.01)。结论:复方甘草酸苷治疗可降低艾滋病患者T细胞部分激活亚群的表达,对艾滋病病毒有一定抑制作用,对艾滋病后的免疫重建有支持作用。     

腹腔镜与开腹直肠癌手术对患者术后免疫功能影响的研究

目的:比较分析腹腔镜与开腹直肠癌根治术对患者免疫功能的影响。方法:将2012年1月至2015年1月同一手术组收治的50例行直肠癌根治术的患者随机分为两组,腹腔镜组(n=25)采用腹腔镜直肠癌根治术,开腹组(n=25)采用开放直肠癌根治术。分别抽取周围静脉血,观察两组患者术前1 d,术后第1天、第3天、第5天、第7天淋巴细胞亚群CD3+、CD4+细胞的数量及血清IL-2水平的变化。结果:两组较术前1 d相比,术后第1天CD3+、CD4+细胞的数量及血清IL-2水平均有不同程度下降,表明围手术期患者的免疫功能均有一定的抑制(P<0.05),而两组此时间点差异无统计学意义(P>0.05);术后第3天、第5天、第7天,腹腔镜组CD3+、CD4+、IL-2与术前相比,无明显降低(P>0.05),而开腹组一直处于较低水平,明显低于术前水平(P<0.05),两组同时间点比较差异有统计学意义(P<0.05)。结论:腹腔镜直肠癌根治术对患者免疫功能影响较小,优于开腹手术,条件允许时应尽可能选择腹腔镜手术,更利于保护患者的免疫功能。     

Impaired immune responses and antigen-specific memory CD4+ T cells in hemodialysis patients

Serologic responses to T cell-dependent vaccinations are severely attenuated in patients with ESRD, but the reasons for this is unknown. In this study, a detailed analysis of antigen-specific T cell responses was performed. Patients on hemodialysis and age- and gender-matched healthy control subjects were vaccinated with hepatitis B surface antigen (HBsAg), antigen-specific CD4(+) T cells were monitored at regular intervals with intracellular cytokine staining and proliferation assays. IL-2-and IFN-gamma-producing CD4(+) T cells were identified as either central or effector memory CD4(+) T cells using antibodies directed against CD45RO and the chemokine receptor CCR7. Control subjects mounted a memory T cell response comprising both central and effector memory CD4(+) T cells, with the central memory response occurring 1 wk before the effector memory response. IL-2(+) HBsAg-specific memory CD4(+) T cells were primarily detected within the effector population. Patients with ESRD showed a delayed response of IL-2-and IFN-gamma-producing central memory CD4(+) T cells, but their maximal responses were similar to those of control subjects. In contrast, patients with ESRD produced only 6.3% of the IL-2(+) HBsAg-specific effector memory CD4(+) T cells produced by control subjects (0.5 +/- 0.2 x 10(4)/L versus 8 +/- 3.5 x 10(4)/L; P < 0.001), and this impaired response correlated with antigen-specific T cell proliferation and anti-HBsAg IgG titers. In conclusion, the production of antigen-specific effector memory CD4(+) T cells after vaccination, which is critical to achieve an adequate humoral response, is severely impaired in patients with ESRD.     

腹腔镜与开腹结直肠癌根治术对机体免疫系统影响的比较研究

目的:比较腹腔镜手术与传统开腹手术对患者免疫机能的影响。方法:2006年12月至2007年7月收治结直肠癌患者60例,分别行腹腔镜手术和开腹手术各30例,于术前1d和术后第3天、第7天抽取外周静脉血,比较两组患者的C反应蛋白,IgA,IgM,IgG,IL-6,CD3+,CD4+,CD8+细胞和NK细胞,比较术前1d和术后第1天、第3天TNF-α细胞活性。结果:术后第3天患者CD3+,CD4+,CD8+细胞活性及CD4+/CD8+差异无显著性,但术后第7天腹腔镜较开腹组明显低。术后第3天IL-6开腹组明显高于腹腔镜组。C反应蛋白于术后第3天开腹组高于腹腔镜组。IgM于术后第3天开腹组高于腹腔镜组,IgA、IgG无显著统计学意义。TNF-α于术后第3天开腹组高于腹腔镜组。结论:腹腔镜结直肠癌根治术较传统开腹手术对机体免疫机能影响较小。     

腹腔镜手术对HIV感染者免疫功能的影响

目的:检测HIV(+)者腹腔镜手术前后主要细胞和体液免疫指标的变化并与HIV(-)者对照,探讨微创手术对HIV感染者主要免疫功能的影响。方法:将42例胆囊疾病患者分为2组:观察组(HIV+)22例,对照组(HIV-)20例。用同样方法施行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)。于术前1d,术后3、7d(POD3,7)检测血常规、白蛋白,CD3、CD4、CD8及其百分比和CD4/CD8;IgG、IgM、IgA,补体C3和C4,CRP。HIV(+)者检测HIV-RNA。常规统计学方法处理所得数据。结果:白细胞总数HIV(-)组>HIV(+)组(POD3,7)(P<0.05)。淋巴和中性粒细胞无显著变化(P>0.05)。白蛋白2组手术前后>35g/L。IgA手术前后HIV(+)>HIV(-)(P<0.05)。IgG、IgGM、C3和C42组手术前后均无显著变化,均在正常范围。CD4HIV(+)者术前1天至术后1月<50copy/ml。组间比较:CD4手术前后HIV(+)0.05)。CD4/CD8手术前后HIV(+)0.05)。CRPHIV(+)组术前>POD3,7(P<0.05)。CRP HIV(-)组术前相似文献   

Human adipose tissue-derived mesenchymal stem cells combined with hematopoietic stem cell transplantation synthesize insulin

BACKGROUND: Type 1 diabetes mellitus (DM) is an autoimmune disorder with disturbed glucose/insulin metabolism, which has no medical treatment other than life-long insulin therapy, despite which 30% of subjects develop organ failure. Herein we have reported the use of human adipose-tissue-derived, insulin-making mesenchymal stem cells (h-AD-MSC) transfused with unfractionated cultured bone marrow (CBM) in 5 insulinopenic DM patients. PATIENTS AND METHODS: Five (M:F, 2:3) insulinopenic DM patients of 0.6 to 10 years' duration, ages 14 to 28 years under treatment insulin (Human with 14-70 U/d) showed postprandial blood sugars between 156 to 470 mg%, glycosylated hemoglobin 6.8% to 9.9% and c-peptide levels of 0.02 to 0.2 ng/mL. They underwent intraportal administration of xenogeneic-free h-AD-MSC (mean dose = 1.5 mL; cell counts, 2.1 x 10(3)/muL). The CD45-/90+/73(+) cells (29.8/16.8%) showed c-peptide levels of 3.08 ng/mL, insulin level of 1578 micro IU/mL. The aliquot was supplemented with CBM (mean dose 94 mL with cell counts: 18.7 x 10(3)/microL) containing CD45-/34+ elements of 0.93%. The Institutional Review Board approved the study protocol and consent forms. RESULTS: All patients were successfully infused CBM plus h-AD-MSC without any untoward effects and showed 30% to 50% decreased insulin requirements with 4- to 26-fold increased serum c-peptide levels, with a mean follow-up of 2.9 months. CONCLUSION: This report describes safe and effective treatment of insulinopenic diabetics using insulin-producing h-AD-MSC plus CBM without xenogeneic materials.     

腹腔镜下结直肠癌手术对机体免疫功能的影响

目的:探讨腹腔镜和开腹结直肠癌根治术对机体免疫功能的影响。方法:2003年12月至2006年3月,同一手术组将60例结直肠癌患者随机分为腹腔镜组和开腹组,各30例。分别于术前1d和术后第3天、1、2周取外周静脉血,测定C反映蛋白(CRP)、IL-6、免疫球蛋白IgA、Ig M、IgG,CD3 、CD4 、CD8 及NK细胞活性进行比较。结果:术后第3天,两组患者外周血CD3 、CD4 、CD4 /CD8 及NK细胞活性比较无显著性差异(P>0·05),开腹组患者术后第1周、2周显著低于腹腔镜组(P<0·01)。IL-6术后第1、3天,开腹组明显高于腹腔镜组(P<0·01)。CRP术后第3、7天,开腹组明显高于腹腔镜组(P<0·01,P<0·05)。Ig M术后第3天腹腔镜组高于开腹组(P<0·05),IgA,IgG两组间无统计学差异(P>0·05)。结论:腹腔镜结直肠癌根治术比传统开腹手术对机体影响小,在免疫功能保护上更具有优势。     

加速康复外科对腹腔镜胃癌根治术患者炎症因子与免疫功能的影响

目的:探讨加速康复外科对腹腔镜胃癌根治术患者炎症因子及免疫功能的影响。方法:将患者分为围手术期加速康复外科模式管理的观察组(n=40)与常规围手术期管理的对照组(n=40),比较两组患者各时段炎性介质(IL-6、IL-8及IL-10)及IgA、IgG、IgM、CD3~+、CD4~+、CD4~+/CD8~+免疫指标水平,并进行对比分析。结果:术后第1天、第3天、第7天,两组患者IL-6、IL-8均显著上升(P0.05),对照组较观察组升高更明显(P0.05)。术后第1天,两组患者IL-10较术前均明显升高(P0.05),观察组升高更明显。术后第1天,两组患者IgA、IgG、IgM水平较术前均明显降低(P0.05)。术后第3天,观察组IgA、IgG水平明显高于对照组(P0.05);两组患者术后IgM水平无明显差异。术后第1天两组患者CD3~+较术前均明显降低(P0.05),对照组下降更明显;观察组术后CD4~+水平与术前相比差异无统计学意义;对照组CD4~+水平明显低于术前(P0.05)。术后第1天、第3天,两组患者CD8~+、CD4~+/CD8~+水平较术前明显降低(P0.05),但两组间差异无统计学意义。结论:加速康复外科模式可减轻腹腔镜胃癌根治术后患者机体炎性反应,并保护机体免疫功能,减少过度炎症反应,同时可在一定程度上降低胃癌细胞的转移、复发。     

Platelet protection by aprotinin in cardiopulmonary bypass: electron microscopic study.

To evaluate the functional integrity of platelets in patients administered the proteinase inhibitor aprotinin during cardiopulmonary bypass, 20 patients undergoing a complicated and prolonged open heart operation were studied. They were randomized to receive either a high dose of aprotinin (total dose, 6 to 7 x 10(6) KIU) before and during cardiopulmonary bypass (10 patients) or a placebo (10 patients). Blood samples were collected preoperatively, at the termination of bypass, and 90 minutes thereafter to assess platelet count and aggregation on extracellular matrix, which was studied by scanning electron microscopy. On a scale of 1 to 4, mean preoperative platelet aggregation grades were similar in both groups (3.5 +/- 0.5). Postoperatively, at the termination of cardiopulmonary bypass and 90 minutes thereafter, all 10 patients treated with aprotinin revealed normal, unchanged platelet aggregation (grade, 3.5 +/- 0.5), whereas all placebo-treated patients showed severely disturbed aggregation (grade, 1.4 +/- 0.5) (p less than 0.001). The platelet count was similar in both groups before and after operation (preoperatively, 182 +/- 75 x 10(9)/L and 146 +/- 30 x 10(9)/L, and postoperatively, 87 +/- 13 x 10(9)/L and 80 +/- 27 x 10(9)/L for the aprotinin and placebo groups, respectively). Total 24-hour postoperative bleeding and blood requirement were significantly lower in the aprotinin group (371 +/- 84 mL and 2 +/- 0.7 units, respectively) compared with the placebo group (608 +/- 28 mL and 3.4 +/- 1.3 units, respectively) (p less than 0.01). These results demonstrate that improved postoperative hemostasis is directly related to the complete preservation of platelet function achieved by the protective properties of aprotinin.     

腹腔镜胆囊切除术对机体免疫功能的影响

目的：比较腹腔镜与开腹胆囊切除术对机体免疫功能的影响。方法：随机将有胆囊切除手术指征的80例患者分为2组,腹腔镜胆囊切除组（laparoscopic cholecystectomy,LC组）和开腹胆囊切除组（open cholecystectomy,OC组）各40例,测定并比较手术前后IgG、IgM、IgA,补体C3、C4水平及CD3^＋（T细胞总数）、CD4^＋（T辅助/诱导细胞）和CD8^＋的数量。结果：两组IgM、IgA、C4手术前后均无明显变化,两组间差异无统计学意义。LC组术后1d IgG、C3较术前有所下降,术后3d恢复至术前水平;OC组术后1d IgG、C3明显低于术前水平,术后5d恢复至术前水平;组间比较,OC组术后IgG、C3下降明显。LC组T淋巴细胞亚群手术前后差异无统计学意义,OC组术后1d CD3^＋、CD4^＋、CD8^＋与术前比较明显降低,术后5d恢复至术前水平;组间比较,术后1d、3d OC组CD3^＋、CD4^＋、CD8^＋均明显低于LC组。结论：腹腔镜手术对机体的免疫功能影响小,术后恢复快。     

Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy

BACKGROUND: Although several studies compare surgical results of laparoscopic and open colonic resections, there is no study of laparoscopic gastrectomy compared with open gastrectomy. HYPOTHESIS: When compared with conventional open gastrectomy, laparoscopy-assisted Billroth I gastrectomy is less invasive in patients with early-stage gastric cancer. DESIGN: Retrospective review of operative data, blood analyses, and postoperative clinical course after Billroth I gastrectomy. SETTING: University hospital in Japan. PATIENTS: The study included 102 patients who were treated with Billroth I gastrectomy for early-stage gastric cancer from January 1993 to July 1999: 49 with laparoscopy-assisted gastrectomy and 53 with conventional open gastrectomy. MAIN OUTCOME MEASURES: Demographic features examined were operation time; blood loss; blood cell counts of leukocytes, granulocytes, and lymphocytes; serum levels of C-reactive protein, interleukin 6, total protein, and albumin; body temperature; weight loss; analgesic requirements; time to first flatus; time to liquid diet; length of postoperative hospital stay; complications; proximal margin of the resected stomach; and number of harvested lymph nodes. RESULTS: Significant differences (P<.05) were present between laparoscopy-assisted and conventional open gastrectomy when the following features were compared: blood loss (158 vs 302 mL), leukocyte count on day 1 (9.42 vs 11.14 x 10(9)/L) and day 3 (6.99 vs 8.22 x 10(9)/L), granulocyte count on day 1 (7.28 vs 8.90 x 10(9)/L), C-reactive protein level on day 7 (2.91 vs 5.19 mg/dL), interleukin 6 level on day 3 (4.2 vs 26.0 U/mL), serum albumin level on day 7 (35.6 vs 33.9 g/L), number of times analgesics given (3.3 vs 6.2), time to first flatus (3.9 vs 4.5 days), time to liquid diet (5.0 vs 5.7 days), postoperative hospital stay (17.6 vs 22.5 days), and weight loss on day 14 (5.5% vs 7.1%). There was no significant difference between laparoscopy-assisted and conventional open gastrectomy with regard to operation time (246 vs 228 minutes), proximal margin (6.2 vs 6.0 cm), number of harvested lymph nodes (18.4 vs 22.1), and complication rate (8% vs 21%). CONCLUSIONS: Laparoscopy-assisted Billroth I gastrectomy, when compared with conventional open gastrectomy, has several advantages, including less surgical trauma, less impaired nutrition, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no decrease in operative curability. When performed by a skilled surgeon, laparoscopy-assisted Billroth I gastrectomy is a safe and useful technique for patients with early-stage gastric cancer.     

Hematologic reconstitution following high-dose and supralethal chemoradiotherapy using stored, noncryopreserved autologous hematopoietic stem cells

Although cryopreservation is the standard for autotransplantation, it has logistic and financial disadvantages in undeveloped countries such as Colombia. In 47 patients, peripheral blood was refrigerated at 4 degrees C up to 144 h before autotransplantation. For mobilization, 27 men and 20 women of median age 37 years affected with hematologic malignancies received G-CSF. The 17 patients in Group 1 showed pre-refrigeration CFU-GM of 2.62 x 10(5)/kg (range 0.36 to 16.6 x 10(5)/kg) and at re-infusion, 1.36 x 10(5)/kg (range 0 to 6.32 x 10(5)/kg) of 83% viability (range, 78% to 96%). These patients showed >0.5 x 10(9)/L granulocytes on day +11 (range, 9 to 15) and >20 x 10(9)/L platelets on day +16 (range, 11 to 44). The 25 patients in Group 2 showed CD34 of 3.9 x 10(6)/kg (range, 0.16 to 9 x 10(6)/kg) and mononuclear cell count (MNC) of 8.7 x 10(8)/kg, reaching >0.5 x 10(9)/L granulocytes at day +13 (range, 10 to 17) and >20 x 10(9)/L on day +15 (range, 14 to 20). Among the 5 patients in Group 3, the average of MNC of 12.7 x 10(8)/kg was reached and >0.5 x 10(9)/L granulocytes on day 11 (range, 10 to 16) and >20 x 10(9)/L on day 14 (range, 10 to 18). No differences were observed between the groups. Refrigeration of stem cells appears to be a simple, effective, and inexpensive method that should be considered for autotransplants within a few days of harvesting when resources are limited for long-term storage.