腹腔镜和开腹直肠癌全直肠系膜切除对机体免疫功能的影响  

Immune response to open and laparoscopic total mesorectal excision with anal sphincter preservation in patients of rectal carcinoma

作　　者：胡建昆[1] 周总光[1] 陈志新[1] 王兰兰[2] 于永扬[1] 刘瑾[2] 张波[1] 李立[1] 陈佳平[1] 

机构地区：[1]四川大学华西医院普外科,成都610041 [2]四川大学华西医院临床免疫实验室,成都610041

出　　处：《中华普通外科杂志》2004年第2期88-90,共3页Chinese Journal of General Surgery

基　　金：国家杰出青年科学基金项目 (3 992 5 0 3 2 )

摘　　要：目的比较经腹腔镜和开腹行直肠癌全直肠系膜切除保留肛门手术对患者免疫功能的影响。方法将 37例行直肠癌全直肠系膜切除保肛术患者分为开腹组 (n =2 1)和腹腔镜组 (n =16 ) ,于术前 1天、术后第 1天、术后第 5天检测血清IL 2、IL 6、TNFα值。术前 1天和术后第 5天检测全血CD3+ CD5 6 + T细胞和CD3-CD5 6 + NK细胞的百分比 ,血清免疫球蛋白IgG、IgM、IgA值。IL 2、IL 6、TNFα值的检测用酶联免疫吸附法 (ELISA) ,Ig的测定用免疫散射比浊法 ,CD3+ CD5 6 + T细胞和CD3-CD5 6 + NK细胞用流式细胞仪进行检测。结果两组手术对CD3+ CD5 6 + T细胞、CD3-CD5 6 + NK细胞、IL 2、IL 6、TNFα和免疫球蛋白的影响差异无显著性意义 (P >0 0 5 )。结论腹腔镜和开腹直肠癌全直肠系膜切除术对患者免疫功能的影响差异无显著性意义。Objective This study was designed to compare the alterations of immune function after laparoscopic and open total mesorectal excision and anal sphincter preservation for rectal cancer. Methods Laparoscopic ( n =16) and open ( n =21) total mesorectal excision & anal sphincter preservation for rectal cancer were performed. Interleukin-2(IL-2), Interleukin-6(IL-6), tumor necrosis factor α(TNFα) were assayed preoperatively and at 1 and 5 day postoperatively. CD3 + CD56 + T lymphocyte, CD3 - CD56 + natural killer cell (NK) and immunoglobulin (IgG/IgM/IgA) were measured. CD3 + CD56 + T lymphocyte and CD3 - CD56 + NK cell were counted using flowcytometry. Enzyme-linked immunosorbent assay (ELISA) was used for IL-2, IL-6 and TNFα determination. Immunoglobulin was assayed using immunonephelometry. Results There was no significant difference in CD3 + CD56 + T lymphocyte and CD3 - CD56 + NK cell, IgG, IgM, IgA , IL-2, IL-6 and TNFα between open and laparoscopic groups( P >0.05). Conclusions There is no difference in immune responses to rectal cancer patients undergoing laparoscopic total mesorectal excision with anal sphincter preservation and those having open surgery.

关 键 词：腹腔镜 开腹全直肠系膜切除术 直肠癌 免疫功能 外科治疗 肛门保留 

分 类 号：R735.37[医药卫生—肿瘤] R730.56[医药卫生—临床医学]