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目的探讨腹腔镜与开腹胃癌根治术疗效及对机体免疫功能影响的比较。方法选取2010年10月至2015年10月间德州市齐河县人民医院收治的135例进展期胃癌患者,根据治疗方法不同分为腹腔镜组(68例)与开腹组(67例)。开腹组患者行传统开腹胃癌根治术,腹腔镜组患者行腹腔镜胃癌根治术。观察两组患者临床疗效、术后并发症发生情况、治疗前后外周血免疫细胞、免疫球蛋白、白细胞介素-6(IL-6)、人类白细胞抗原Ⅱ型(HLA-DR)和C反应蛋白(CRP)的变化。结果腹腔镜组患者术中出血量、手术时间、切口长度、排气时间和住院时间均低于开腹组患者,差异均有统计学意义(均P<0.05)。两组患者淋巴结清扫数量比较,差异无统计学意义(P>0.05)。手术后,腹腔镜组患者CD4+和CD4+/CD8+明显高于开腹组患者;腹腔镜组患者术后24h和术后7d的Ig A、Ig G、Ig M和HLA-DR水平均明显高于开腹组患者,IL-6和CRP水平明显低于开腹组患者,差异均有统计学意义(均P<0.05)。开腹组患者并发症发生率为9.0%,腹腔镜组为4.4%,两组患者并发症发生率和CD8+水平比较,差异均无统计学意义(均P>0.05),结论相较于传统开腹手术,腹腔镜手术具有手术时间短、出血量少、创伤小和恢复快等优势,且无明显的免疫抑制作用。
Objective To investigate the effects of laparoscopic and open radical gastrectomy on gastric mucosal immune function. Methods A total of 135 patients with advanced gastric cancer who were admitted to Qihe County People’s Hospital of Dezhou from October 2010 to October 2015 were divided into laparoscopic group (68 cases) and open group (67 cases) according to the method of treatment. Patients in the open group underwent conventional open radical gastrectomy and laparoscopic radical gastrectomy in patients undergoing laparoscopic surgery. The clinical efficacy, postoperative complications, peripheral blood immune cells, immunoglobulin, interleukin-6 (IL-6), human leukocyte antigen type Ⅱ (HLA-DR) and C-reactive protein (CRP) changes. Results The intraoperative blood loss, operation time, incision length, exhaust time and hospital stay in laparoscopic group were significantly lower than those in open group (all P <0.05). There was no significant difference in the number of lymph node dissection between the two groups (P> 0.05). After operation, the levels of CD4 + and CD4 + / CD8 + in laparoscopic group were significantly higher than those in open group; the levels of Ig A, Ig G, Ig M and HLA-DR in laparoscopic group were significantly higher than those in open group at 24h and 7d The levels of IL-6 and CRP in the abdominal group were significantly lower than those in the open group (all P <0.05). The incidence of complications in the open group was 9.0% and in the laparoscopic group was 4.4%. There was no significant difference in complication rates and CD8 + levels between the two groups (all P> 0.05) Laparotomy, laparoscopic surgery has the advantages of short operation time, less bleeding, less trauma and rapid recovery, and no significant immunosuppressive effect.