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目的观察比较腹腔镜和开腹结直肠癌根治术对机体炎症免疫功能的影响。方法将45例结直肠癌患者随机分为腹腔镜组23例和对照组22例,分别于术前及术后1d、7d测定IgA、IgM、IgG、CD3+、CD4+、CD8+、NK细胞活性、IL-6、IL-10、TNF-α及CRP,并进行比较。结果两组患者术后第3d时,CD3+、CD8+较术前明显降低,开腹组术后7d时CD3+、CD4+较腹腔镜组降低更明显,两组患者NK细胞活性手术前后无显著变化;两组患者术后3d和7d时,各种体液免疫因子均有所下降,但腹腔镜组在术后3d时IgM明显高于开腹组,其他指标在术后3d及7d时均无显著差异。两组患者在术后3d和7d时,CRP较术前均明显升高,但腹腔镜组CRP浓度明显低于开腹组(P<0.05),且CRP降低更快,两组患者术后3d时TNF-α及IL-6均明显高于术前,腹腔镜组IL-6术后3d及7d时均低于开腹组(P<0.05),且腹腔镜在术后7d时TNF-α恢复到术前水平,术后IL-10明显高于开腹组(P<0.05)。结论腹腔镜结直肠癌根治术比传统开腹手术对机体免疫系统影响小,炎症反应轻。
Objective To compare the effects of laparoscopic and open radical resection of colorectal cancer on the inflammatory and immune function of the body. Methods Totally 45 patients with colorectal cancer were randomly divided into laparoscopic group (n = 23) and control group (n = 22). IgA, IgM, IgG, CD3 +, CD4 +, CD8 + and NK cell activity were measured before operation and at the 1st, -6, IL-10, TNF-αand CRP, and compared. Results In the two groups, CD3 + and CD8 + were significantly lower than preoperatively at the third day after operation. CD3 + and CD4 + decreased more significantly in the laparotomy group than those in the laparoscopic group at 7 days after operation. There was no significant change in NK cell activity between the two groups At 3d and 7d after operation, all kinds of humoral immune factors decreased. However, the IgM of laparoscopic group was significantly higher than that of laparotomy group on the third day after operation. Other indexes were not significantly different at 3d and 7d after operation. The CRP levels in both groups were significantly higher than those before operation at 3d and 7d after operation, but the CRP levels in laparoscopic group were significantly lower than those in open group (P <0.05), and the CRP decreased more rapidly. The postoperative 3d The levels of TNF-α and IL-6 in the laparoscopic group were significantly lower than those in the laparotomy group at 3d and 7d after operation (P <0.05) The level of IL-10 in postoperative patients was significantly higher than that in open group (P <0.05). Conclusion Laparoscopic radical resection of colorectal cancer than the traditional open surgery on the body’s immune system has little effect, mild inflammatory response.