腹腔镜与传统开腹结直肠癌手术对免疫应激的影响

目的:探讨腹腔镜与传统开腹结直肠癌手术对患者机体免疫应激的影响,以评价腹腔镜结直肠癌手术的优势。方法:随机将60例结直肠癌患者分为腹腔镜组(n=30)与传统开腹组(n=30)。分别于术前、手术结束时、术后第1天、术后第3天抽取患者外周静脉血2 ml,测定T细胞亚群、一氧化氮(NO)的释放及活性氧(reactive oxygen species,ROS)的水平。结果:腹腔镜组对患者T细胞改变的影响明显低于传统开腹组;腹腔镜组对患者血清中NO、外周血单核细胞及中性粒细胞无明显影响,但传统开腹组显著增强患者血清中NO的分泌量及ROS的释放。结论:腹腔镜结直肠癌手术引起的免疫应激反应明显低于传统开腹手术,免疫抑制持续时间短,且抑制强度弱,相应减少了手术并发症,利于患者的术后康复。

Influence of laparoscopic surgery and traditional open surgery for colorectal cancer on immune stress

Objective：To investigate the influence of laparoscopic operation and traditional open operation on immune stress in the treatment of colorectal cancer,in order to evaluate the advantages of laparoscopic surgery for colorectal cancer. Methods：Sixty color-ectal cancer patients were randomly divided into two groups ： laparoscopic group （ n = 30 ） and open group （ n = 30 ）. 2 ml peripheral blood of each group was collected in 1 day before surgery, and Oth, 1 st,3rd day after the operation. The percentages of CD3, CD4, CD8 and CD4/CD8 were assayed by flow cytometry （FCM）. The production of NO was detected by Griess assay. ROS was labeled with DR123 and measured by FCM. Results：A decrease （P 〈 0. 005 ） was observed regarding the percentage of CD3, CD4, CD8 and CIM/ CD8 to surgery in patients after laparoseopic and open surgery. Compared with traditional open group, the change of T cell was less in laparoscopie group. The production of NO, ROS, peripheral blood mononuclear cells and neutrophils did not show significant differences after laparoscopic surgery, but NO and ROS significantly increased after open surgery （ P 〈 0.005 ）. Conclusions ： Our findings showed a significant immunologic advantage in immune stress in laparoscopic operation compared with open operation, which includes less im-mune stress, shorter and weaker immunologic suppression. Providing patients with a comfortable recovery, laparoseopic operation for colorectal cancer decreases operative complications.