腹腔镜下肝部分切除术治疗原发性肝癌患者外周血T淋巴细胞亚群和血清细胞因子水平的变化*

目的 探讨腹腔镜肝部分切除术治疗原发性肝癌（PLC）患者外周血T淋巴细胞亚群和血清细胞因子水平的变化。方法 2014年2月~2015年2月于我院治疗的PLC患者68例,采用随机数字表法分为腔镜组34例和开腹组34例,分别在不同方式下行肝肿瘤切除术。采用免疫浊度法检测血清IgG、IgA、IgM含量,采用酶联免疫吸附法检测血清血管内皮生长因子（VEGF）、成纤维细胞生长因子（aFGF）和bFGF水平,使用流式细胞仪检测外周血CD3⁺、CD4⁺和CD8⁺T细胞百分比。结果 术前,两组外周血CD3⁺、CD4⁺、CD8⁺T细胞百分比无显著性差异（P>0.05）,术后7 d,腔镜组CD3⁺、CD4⁺、CD8⁺T细胞百分比分别为（57.2±5.6） %、（46.9±7.2）%和（28.4±5.3） %,与开腹组比,存在显著性差异【分别为（51.9±3.2） %、（41.2±6.4） %和（33.6±2.3） %,P<0.05】;血清VEGF、aFGF和bFGF水平分别为（18.4±5.1） ng/ml、（5.3±4.2） pg/ml和（6.5±4.3） pg/ml,显著低于开腹组【分别为（31.9±5.7）ng/ml、（8.7±5.2） pg/ml和 （8.4±6.9） pg/ml,P<0.05】;两组肝功能指标和血清免疫球蛋白水平变化无显著性差异（P>0.05）。结论 腹腔镜下肝切除术与开腹肝切除术治疗PLC患者比,可能因为创伤小而对机体的免疫功能影响较小。

Effect of 1aparoscopic hepatectomy on peripheral blood T lymphocyte subsets and serum cytokines in patients with primary liver cancer

Objective To investigate the effect of 1aparoscopic hepatectomy on peripheral blood T lymphocyte subsets and serum cytokines in patients with primary liver cancer（PLC）. Methods 68 patients with PLC were recruited in our hospital between February 2014 and February 2015,and were randomly divided into two groups with 34 in each. 34 patients received laparoscopic hepatectomy and another 34 received open hepatectomy. The peripheral blood T lymphocyte subsets and serum cytokines,immunoglobulin levels were assayed and compared between the two groups. Results The percentages of peripheral blood CD3⁺,CD4⁺ and CD8⁺T cells in the two groups at presentation were not significantly different（P>0.05）,while the CD3⁺,CD4⁺ and CD8⁺T cells in patients receiving laparoscopic hepatectomy seven days after operation were（57.2±5.6）%,（46.9±7.2）% and （28.4±5.3） %,significantly different as compared to（51.9±3.2）%,（41.2±6.4）% and（33.6±2.3）%] in open hepatectomy,respectively,（P<0.05）;serum vascular endothelial growth factor（VEGF）,fibroblast growth factors-a （aFGF） and bFGF levels were （18.4±5.1） ng/ml,（5.3±4.2） pg/ml and （6.5±4.3） pg/ml,much lower than （31.9±5.7） ng/ml,（8.7±5.2） pg/ml and（8.4±6.9） pg/ml,respectivley,in open hepatectomy,P<0.05];the changes of blood liver function index and immumoglobulin levels in the two groups were not significantly different（P>0.05）. Conclusion The impact of laparoscopic hepatectomy on immune functions is milder than open operation, might be related to its mild injuries in the process.