腹腔镜与开腹直肠癌根治术对局部与全身免疫反应影响的对比研究

目的比较腹腔镜与开腹直肠癌手术对机体局部和全身炎症免疫反应的影响。方法 2005年4月～2006年2月40例直肠癌分为开腹组20例和腹腔镜组20例,术前第1天、术后第1天和第3天分别采集外周静脉血,测定C反应蛋白(CRP)、白细胞(WBC)、白介素6(IL-6)、CD4、CD8、自然杀伤细胞(NK细胞)和淋巴细胞,术后第1天和第3天腹腔引流液送检测定WBC、IL-6。结果腹腔镜与开腹直肠癌根治术对WBC、CD4、CD8、CD4/CD8、NK细胞和淋巴细胞的影响差异无显著性意义(P0.05)。开腹组术后第1、3天血CRP分别为(109.9±36.2)、(80.9±26.3)mg/L,显著高于腹腔镜组(83.9±37.7)mg/L(t=2.226,P=0.032),(58.6±30.4)mg/L(t=2.485,P=0.017)。开腹组术后第1、3天血IL-6分别为(92.6±21.0)、(71.6±18.4)pg/ml,显著高于腹腔镜组(73.7±20.9)pg/ml(t=2.853,P=0.007),(57.3±19.3)pg/ml(t=2.398,P=0.021)。2组术后第1、3天腹腔引流液WBC差异无显著性意义(P0.05),腹腔引流液IL-6开腹组术后第1天(164.8±54.0)pg/ml和术后第3天(121.6±45.9)pg/ml明显高于腹腔镜组术后第1天(128.3±55.4)pg/ml(t=-2.112,P=0.041)和术后第3天(90.7±48.2)pg/ml(t=-2.076,P=0.044)。腹腔镜组术中出血量(142.7±104.8)ml比开腹组(246.0±146.4)ml明显减少(t=-2.565,P=0.014),肠道功能恢复时间(51.0±19.1)h与开腹组相比明显缩短(81.1±21.6)h(t=-4.669,P=0.000),术后住院时间(10.7±2.8)d与开腹组(13.7±5.3)d相比差异有显著性(t=-2.238,P=0.031)。2组手术时间、肿瘤下切缘距离、肿瘤直径、清除淋巴结数和并发症比较无显著性意义(P0.05)。结论腹腔镜直肠癌根治术与开腹手术相比对机体炎症免疫反应的影响小,是一种安全、创伤小、恢复快的手术方式。

Comparison of Local and Systemic Immunoreactions after Laparoscopic and Open Radical Resection for Rectal Cancer

Objective To compare the changes in peritoneal and systemic immune response after laparoscopic and open radical resection for rectal cancer. Methods From April 2005 to February 2006,40 patients with rectal cancer underwent radical resection of the rectum; 20 of them underwent laparoscopic surgery and the other 20 received open resection. The peripheral blood was collected from the patients one day before,and one and three days after the operation to determine the levels of WBC,CRP,IL-6,CD4,CD8,CD4/CD8,NK cells and lymphocyte. The abdominal drainage fluid was collected for WBC and IL-6 measurement on days 1 and 3 postoperation. Results No significant difference was detected in the levels of WBC,CD4,CD8,NK cell and lymphocyte between the two groups （P0.05）. On days 1 and 3 postoperation,the blood levels of CRP and IL-6 in the open group were significantly higher than those in the laparoscopy group [CRP：（109.9±36.2） mg/L and （80.9±26.3） mg/L vs. （83.9±37.7） mg/L （t=2.226,P=0.032） and （58.6±30.4） mg/L （t=2.485,P=0.017）; IL-6：（92.6±21.0） pg/ml and （71.6±18.4） pg/ml vs.（73.7±20.9） pg/ml （t=2.853,P=0.007） and （57.3±19.3） pg/ml （t=2.398,P=0.02）]. No significant difference was observed in the level of WBC in the abdominal drainage fluid after operation between the two groups （P0.05）; whereas,the level of IL-6 in the drainage fluid in the open group was significantly higher than that in the laparoscopy group both at days 1 and 3 postoperation [（164.8±54.0） pg/ml and （121.6±45.9） pg/ml vs. （128.3±55.4） pg/ml （t=-2.112,P=0.041）,and （90.7±48.2） pg/ml （t=-2.076,P=0.044）]. The intraoperative blood loss,recovery time of gastrointestinal function,and postoperative hospital stay in the laparoscopy group were significantly less than those in the open group [（142.7±104.8） ml vs. （246.0±146.4） ml,t=-2.565,P=0.014; （51.0±19.1） h vs. （81.1±21.6） h,t=-4.669,P=0.000; and （10.7±2.8） d vs. （13.7±5.3） d,t=-2.238,P=0.031]. No significant difference was noticed in the operation time,distal margin,tumor diameter,lymph node harvested,and morbidity rate between the two groups. Conclusions Laparoscopic surgery has less influence on the immune system than open surgery. Laparoscopic radical resection is a safe,minimally invasive method for rectal cancer resulting in quick recovery in patients.