腹腔镜和开腹胃癌根治术对患者机体炎性反应和免疫功能的影响  

Effect of laparoscopic radical gastrectomy and open radical gastrectomy on inflammatory reaction and immune function in patients with gastric cancer

作　　者：张杰[1] 郭媛[2] 王卫[1] 李敬[1] 贺鹏[1] 于立书 左慧肖 

机构地区：[1]内蒙古自治区包头市肿瘤医院腹部外科,包头014030 [2]内蒙古自治区包头市第四医院眼科,包头014030

出　　处：《中国肿瘤临床与康复》2016年第10期1153-1156,共4页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨腹腔镜和开腹胃癌根治术对患者机体炎性反应和免疫功能的影响。方法选取2014年7月至2015年7月间在包头市肿瘤医院行手术治疗的45例胃癌患者的临床资料进行分析。根据手术方式不同将45例患者分为腹腔镜组(20例)和开腹组(25例)。对两组患者的临床疗效、手术前、后血清炎性反应指标和免疫指标进行比较。结果两组患者手术后第1、3、7天外周血CD_3^+、CD_4^+和CD_8^+检测结果较手术前均下降,差异有统计学意义(P<0.05)。手术后第1天两组患者的免疫球蛋白IgG、IgA和IgM水平较术前均下降,差异有统计学意义(P<0.05)。手术后第7天腹腔镜组患者的免疫球蛋白水平已接近手术前(P>0.05),而开腹组仍低于手术前水平(P<0.05)。手术后第1、3天,两组患者的C-反应蛋白(CRP)、白介素6(IL-6)水平均高于手术前,差异有统计学意义(P<0.05);手术后第1天,两组患者的CRP和IL-6的变化差异无统计学意义(P>0.05);手术后第7天,两组患者的CRP和IL-6均有所恢复,但腹腔镜组优于开腹组,差异有统计学意义(P<0.05)。结论与开腹手术比较,腹腔镜手术对机体免疫功能和炎性反应的影响较小,有利于患者机体的恢复,值得临床推广应用。Objective To discuss the effect of laparoscopic radical gastrectomy（ LRG） and open radical gastrectomy（ ORG） on inflammatory reaction and immune function in patients with gastric cancer.Methods Clinical data of 45 patients with gastric cancer undergoing surgery at Baotou Cancer Hospital from July 2014 to July 2015 were analyzed. Patients were sorted into LRG group（ n = 20） and ORG group（ n = 25） according to the mode of operation. Clinical efficacy,preoperative and postoperative serum inflammatory indicators,and immune indicators were compared between the two groups. Results On days 1,3and 7 after surgery,CD3＋,CD4＋ and CD8＋ in the peripheral blood were significantly decreased in both groups compared with those preoperatively,and the difference was statistically significant（ P 〈 0. 05）. On the first day after surgery,the levels of IgG,IgA and IgM significantly decreased compared with those preoperatively in both groups,and the difference was statistically significant（ P 〈 0. 05）. On day 7 after operation,the levels of immunoglobulin in LRG group was close to that before surgery（ P 〉 0. 05） but the level in ORG group sustained lower than preoperatively（ P 〈 0. 05）. On days 1 and 3 after operation,C-reactive protein（ CRP）,interleukin（ IL）-6 level significantly increased in both groups compared with those preoperatively,with statistically significant differences between groups（ P 〈 0. 05） However,there was no statistically significant difference in the changes of CRP and IL-6 between groups on the first day after operation（ P 〉 0. 05）. And the level of the two indexes somewhat recovered gradually in both groups on day 7 after operation,with LRG group superior to ORG group（ P 〈 0. 05）. Conclusion Compared with ORG group,LRG has less influence on immune function and inflammatory reaction,which is beneficial to the recovery of the body and worthy of clinical popularization and application.

关 键 词：胃肿瘤 腹腔镜 外科手术 全身炎症反应综合征 

分 类 号：R735.2[医药卫生—肿瘤]