【作者】 王贵英； 于跃明； 钟锋；

【Author】 Wangguiying Yuyueming Zhongfeng Department of second surgery,the Fourth Hospital of Hebei Medical University.Shijiazhuang 050011,China

【机构】 河北医科大学第四医院暨河北省肿瘤医院外二科；

【摘要】 目的手术创伤会引起机体生理和免疫功能的改变,手术创伤的大小对早期炎症反应程度的影响至关重要,传统开腹手术会影响机体防御功能,从而使机体免疫功能下降。随着腹腔镜直肠癌手术广泛开展,评价腹腔镜直肠癌根治术对机体炎症免疫反应的影响显得非常重要。本研究的目的在于比较腹腔镜与开腹直肠癌手术对机体免疫因子及临床指标影响的差异,明确腹腔镜直肠癌切除术对机体免疫功能的影响。方法选取我院2007年5月-2008年1月间收治的直肠癌患者47例。其中开腹手术组24例,腹腔镜手术组23例。术前第1天、术后第1天和第5天分别采集外周静脉血,测定C反应蛋白(CRP)、IgG、IgA、IgM、C3、C4、CD4、CD8、CD3、CD56、CD4/CD8,比较两组病人的免疫指标和观察近期临床疗效。结果所有47例直肠癌患者均顺利完成手术,其中腹腔镜手术组23例无中转开腹。腹腔镜与开腹直肠癌切除术对IgG、补体C3、补体C4、CD56、CD4/CD8的影响无显著差异(P>0.05),两手术组对CRP、IgM、IgA、CD4、CD8、CD3的影响有显著差异(P<0.05),即腹腔镜手术组对机体影响小。腹腔镜组术中出血量比开腹组明显减少(P<0.05),腹腔镜手术组肠道功能恢复时间、术后住院时间显著缩短,与开腹组相比有显著差异(P<0.05)。两手术组在手术时间、术后并发症方面比较无显著性差异(P>0.05)。结论腹腔镜手术患者术中出血少,术后胃肠功能恢复快,住院天数短,提示有良好的社会经济效益。腹腔镜直肠癌切除术与传统开腹手术相比对机体免疫功能的影响更小。因此,腹腔镜直肠癌切除术是一种安全、创伤小、恢复快的手术方式。更多还原

【Abstract】 Objective Surgical trauma may cause the change of organism in physiology and immune function. The extent of surgical trauma significantly affect the level of inflammatory during earlier period.Traditional operation on abdominal region can influence the defense function of organism accordingly to causeing the decent of immune function. Accompanied with the widespread use of abdominal speculum in rectal cancer,it is important to evaluate the effect on inflammatory reaction.To study the alterations of immune function afer laparoscopic and open operation in patients with rectal cancer.Methods:Forty seven patients with rectal cancer were divided into laparoscopic group(with 23 patients) and open operation group(with 24 patients) from May 2007 to January 2008.C-reactive protein(CRP),IgG,IgA,IgM, C3,C4,CRP,CD4,CD8,CD3,CD56 CD4/CD8 in peripheral blood were assayed at 1 day before operation,1 day and 5 day after operation to compare with two group of patient’s immunity targets and observe in the near future clinical curative effect.Results:Forty seven patients with rectal cancer resection were all completed successfully and there was no conversion to an open approach in laparoscopic group.There was no significant difference in IgG,C3,C4,CD56,CD4/ CD8,between open and laparoscopic groups(P>0.05).Statistical analysis indicates that there is a statistical significance (P<0.05),that is the Laparoscopic Surgery has minor effect on the level of serumCRP,IgM,IgA,CD4,CD8,CD3 than the open surgery.The mean operative blood loss in laparoscopic group was lower than that in open group(P<0.05).The operative blood loss in laparoscopic group was significantly lower than that in open group(P<0.05).In laparoscopic group,the intestinal function recovery time and evacuation time were significantly shortened.The difference was significant when compared with the open group(P<0.05).There was no significant difference between the two groups in operative time and complication.Conclusion:The patients of laparoscopic rectal carcinoma surgery bleed a little, recover quickly in terms of stomach affection and stay in hospital for a shorter time,which demonstrates good efficiency of social and economy.Laparoscopic operation has less effect on immune function in patients with rectal cancer than traditional open surgery.Laparoscopic rectal cancer surgery is a kind of safe,minimally insult,rapid recovery operation.更多还原