微创医学

目的探讨腹腔镜与开腹结直肠癌根治术对患者免疫功能的影响,并观察临床应用价值,从而选择最佳的手术方法。方法回顾性分析100例结直肠癌患者的临床资料,按照自愿、对照的原则分为观察组和对照组,各为50例。观察组采用腹腔镜进行手术,对照组采用传统的开腹手术。观察和比较两组患者术前1 d、术后1、2、3、7 d免疫功能指标T细胞CD3+、CD4+、CD8+的变化情况。结果术前1 d两组患者T淋巴细胞CD3+、CD4+、CD8+比较差异无统计学意义(P>0.05);术后1 d两组患者T淋巴细胞CD3+、CD4+、CD8+均有所下降,但是对照组下降幅度大于观察组,差异有统计学意义(P<0.01);术后3 d、5 d两组患者T淋巴细胞CD3+、CD4+、CD8+均有所上升,但是观察组上升幅度大于对照组,差异有统计学意义(P<0.01);术后7 d观察组T淋巴细胞CD3+、CD4+、CD8+基本恢复到术前水平,与对照组相比,差异有统计学意义(P<0.01)。结论采用传统的开腹手术对结直肠癌患者进行根治手术创伤较大,对患者细胞免疫功能的影响较大,而腹腔镜结直肠癌根治术效果较好,可以减轻对机体细胞免疫功能的抑制作用,且术后恢复较快,是一种安全可行的手术方式。

Objective To discuss the effects of radical laparoscopic and open resections for colorectal cancer on immunologic function，and to observe the clinical value，so as to choose the best surgical method． Method Data collected from 100 cases of patients with colorectal cancer were reviewed． Those patients were equally divided into two groups，respectively as observation group and control group． Patients in the observation group went through laparoscopic surgery and the patients in the control group went through conventional open surgery． The changes of CD3 +、CD4 +、CD8 + T lymphocytes as the immune function index of two groups 1 day before the surgery and 1 day，2 days，3 days，and 7 days after the surgery were observed and compared． Results 1 day before the surgery，the levels of CD3 + ，CD4 + ，and CD8 + T lymphocytes in patients of two groups were statistically insignificant ( P ＞ 0． 05 ) ; but 1 day after the surgery，CD3 + ，CD4 + ，CD8 + T lymphocytes in patients of both two groups were all reduced，with the larger reducing range was observed in the control group than in the observation group，and the difference was significant( P ＜ 0． 01) ; 3 days，and 5 days after the surgery，CD3 + ，CD4 + ，and CD8 + T lymphocytes in patients of both two groups increased，with the larger increasing range was observed in the observation group than in the control group，and the difference was significant( P ＜ 0． 01 ) ; 7 days after the surgery，CD3 + ，CD4 + ，and CD8 + T lymphocytes in patients of observation group had generally restored to the preoperative level，and significantly different to those of the control ( P ＜ 0． 01) ． Conclusions The conventional radical open resection for colorectal cancer can result in more traumas，and produce greater influence upon cellular immune function，while the radical laparoscopic resection for colorectal cancer has good effects，which can reduce the inhibition to the cellular immune functionand has fast recovery． So，the radical laparoscopic resection is a secure and feasible surgical method and worth being clinically promoted．