腹腔镜和开腹直肠癌根治术对机体免疫功能的影响

目的探讨腹腔镜直肠癌根治术(Miles)围手术期免疫功能的变化。方法40例行Miles的患者分为2组,腹腔镜组(L组)和传统开腹组(O组),每组20例。分别于术前1d,术后第1天、第2天、第3天抽取患者外周静脉血,检测辅助T淋巴细胞(TH)2个亚群Th1、Th2细胞含量、Th1/Th2及白细胞介素-2(IL-2)、IL-6含量。术前1d和术后第3天检测全血CD3 CD56 T细胞和CD3-CD56 自然杀伤(NK)细胞的百分比。IL-2、IL-6的检测用酶联免疫吸附法(ELISA),CD3 CD56 T细胞和CD3-CD56 NK细胞用流式细胞仪进行检测。结果术后第1天,L组Th1细胞含量高于O组(P<0.05);术后第1天、第2天、第3天,L组Th2细胞含量低于O组,Th1/Th2高于O组(P<0.05);术后第2天,L组IL-2含量高于O组,术后第1天L组IL-6含量低于O组(P<0.05)。2组手术对CD3 CD56 T细胞、CD3-CD56 NK细胞的影响差异有显著性意义(P<0.05)。结论Miles对患者术后免疫功能的抑制有一定的保护作用,对肿瘤患者的预后有益。

Influence of laparoscopic and open abdominoperineal resection on immune function in rectal cancer patients

Objective To compare the immune function alterations of patients with rectal cancer after laparoscopic and open abdominoperineal resection. Methods Forty patients undergoing abdominoperineal resection were divided into two groups: laparoscopic (group L) and open procedure(group O). Peripheral blood samples were collected the day before operation and 1,2 and 3 days after operation. Th1,Th2 cells, the ratio of Th1/Th2 and interleukin-2(IL-2),interleukin-6(IL-6) were measured respectively. The percentage of CD3 CD56 T lymphocytes and CD3-CD56 natural killer(NK) cells were detected the day before operation and 3 days after operation. CD3 CD56 T lymphocytes and CD3-CD56 NK cells were counted using flowcytometry. Enzyme-linked immunosorbent assay (ELISA) was used for IL-2, IL-6 determination. Results The number of Th1 cell in group L was more than that of group O one day after operation (P<0.05). Th2 lymphocyte count was less and the ratio of Th1/Th2 was larger than that of group O 1,2,3 days after operation (P<0.05). The level of IL-2 was higher than that of group O at the 2nd day and the level of IL-6 was less than that of group O at the 1st day after surgery. There was significant difference in CD3 CD56 T lymphocyte and CD3 - CD56 NK cell(P<0.05). Conclusions The immune function of patients with rectal cancer undergoing laparoscopic abdominoperineal resection could be protected, which may be beneficial to the prognosis.