腹腔镜与开腹胃癌根治术的疗效及对患者免疫功能的影响

目的:比较腹腔镜与开腹胃癌根治术的疗效及对患者免疫功能的影响.方法:回顾性分析3年内收治的1 14例胃癌患者临床资料,其中55例行腹腔镜胃癌根治术(腹腔镜组)和59例行开腹胃癌根治术(开腹组),比较两组术后免疫功能的变化,以及术中、术后情况.结果:术后24,72 h免疫指标检测显示,两组患者IL-2和IL-6浓度均较术前明显升高(均P＜0.05),但开腹组两者升高程度大于腹腔镜组(均P＜0.05)；开腹组外周血CD3+,CD4+,CD8+细胞水平均较术前明显下降(均P＜0.05),但以上T细胞亚群在腹腔镜组未见明显变化(均P＞0.05).与开腹组比较,腹腔镜组术中出血量、止痛药物使用次数、并发症均明显减少,首次排气时间、进食时间和下床活动时间,以及术后住院时间均明显缩短(均P＜0.05).结论:腹腔镜胃癌根治术对患者术后免疫功能影响少,机体损伤小,临床效果优于开腹手术.

Laparoscopic versus open gastric radical gastrectomy: the efficacy and impact on immune function

Objective: To compare the efficacies between laparoscopic and open radical gastrectomy and their impacts on immune function of patients. Methods: The clinical data of 114 gastric cancer patients admitted over the past 3 years were retrospectively analyzed. Of the patients, 55 cases underwent laparoscopic gastrectomy (laparoscopy group) while 59 cases were subjected to open gastrectomy (laparotomy group). The postoperative immune function alterations, and intra- and postoperative conditions between the two groups of patients were compared. Results: The determination results for immune function parameters at 24 and 72 h after operation showed the levels of IL-2 and IL-6 in both groups were increased significantly compared with those before operation (all P<0.01), but the increasing degrees of both factors in laparotomy group were greater than those in laparoscopy group (all P<0.05); the peripheral blood levels of CD3+, CD4+, and CD8+ cells in laparotomy group were decreased significantly versus those before operation (all P<0.05), while no significant changes in above T cell subsets were noted in laparoscopy group (all P>0.05). Compared with laparotomy group, the intraoperative blood loss, frequency in analgesic use and postoperative complications in laparoscopy group were significantly reduced, and times to first flatus passage, liquid diet and ambulation as well as length of postoperative hospital stay were significantly shortened (all P<0.05).Conclusion: The efficacy of laparoscopic gastrectomy is better than that of open surgery, because it exerts less impact on immune function and with little systemic damage on the patients.