比较腹腔镜辅助与开腹胃癌根治术对患者急性期反应及细胞免疫功能的影响

Effect of laparoscopic-assisted radical gastrectomy vs open radical gastrectomy on acute phase response and cellular immune function: A comparative study

  • 摘要: 目的 比较腹腔镜辅助胃癌根治术与开腹胃癌根治术对机体急性期反应及细胞免疫功能的影响。 方法 回顾性分析2014年9月-2015年9月于本院普通外科住院手术治疗的179例胃癌患者临床病理资料。腹腔镜组82例,开腹组97例,两组资料具有可比性(P>0.05)。比较两组术前1 d,术后1 d、2 d、3 d、7 d外周血C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)浓度及淋巴细胞计数、中性粒细胞计数、中性粒细胞计数/淋巴细胞计数水平。 结果 与开腹组相比,腹腔镜组术中出血量少(152.32±98.18) ml vs (238.97±138.03) ml,P<0.05,手术时间略长(211.44±54.58) min vs (191.32±50.15) min,P<0.05,淋巴结清扫数目相近(25.26±1.44) vs (24.97±1.94),P>0.05。两组CRP、IL-6水平及中性粒细胞计数、淋巴细胞计数、中性粒细胞计数/淋巴细胞计数均在正常范围内,无统计学差异(P均>0.05)。两组CRP、IL-6术后1 d、2 d、3 d、7 d均较术前明显升高(P<0.05);CRP在术后第2天达到峰值,IL-6在术后第1天达到峰值;术后同一时点,腹腔镜组CRP,IL-6水平均低于开腹组(P<0.05)。两组中性粒细胞计数、中性粒细胞计数/淋巴细胞计数比值术后第1、2、3、7天均较术前明显升高(P<0.05),淋巴细胞计数较术前明显下降(P<0.05);中性粒细胞计数、中性粒细胞计数/淋巴细胞计数在术后第1天达到峰值,淋巴细胞计数在术后第1天降到最小值;术后同一时点,腹腔镜组中性粒细胞计数、中性粒细胞计数/淋巴细胞计数低于开腹组,淋巴细胞计数则高于开腹组(P<0.05)。 结论 腹腔镜手术与开腹手术相比,术中出血量少,手术效果相近,手术时间稍长,引起的急性期反应及细胞免疫抑制程度轻。

     

    Abstract: Objective To compare the effects of laparoscopic-assisted radical gastrectomy and open radical gastrectomy on acute phase response and cellular immune function. Methods Retrospective clinicopathologic data of 179 patients with gastric cancer from September 2014 to September 2015 in the Department of Chinese PLA General Hospital was collected. Of which, 82 cases underwent laparoscopicassisted gastrectomy (laparoscopic group), and 97 cases with open radical gastrectomy (open group). The baseline data of the two groups showed no statistically significant difference(P> 0.05). The levels of CRP, IL-6, lymphocyte count, neutrophil count, neutrophil count/lymphocyte count ratio in the two groups were compared preoperatively and at day 1, 2, 3, 7 after the operation. Results Compared with the laparotomy group, the laparoscopic group had less blood loss(152.32±98.18)ml vs (238.97±138.03) ml, P< 0.05, slightly longer operative time(211.44±54.58) min vs (191.32±50.15) min, P< 0.05and similar dissected lymph nodes(25.26±1.44) vs (24.97±1.94), P> 0.05. The CRP, IL-6 level, neutrophil count, lymphocyte count, neutrophil count/lymphocyte count ratio were within the normal range with no significant difference (P> 0.05). The levels of CRP and IL-6 were significantly increased on day 1, 2, 3, 7 after operation (P< 0.05); CRP peaked on day 2 after operation and IL-6 peaked on day 1 after operation (P< 0.05, respectively); The levels of CRP and IL-6 in the laparoscopic group were lower than those in the laparotomy group at day 1, 2, 3, 7 after operation (P< 0.05, respectively). The neutrophil count and neutrophil count/lymphocyte count ratio in two groups at day 1, 2, 3, 7 after operation were significantly higher than those before operation (P< 0.05, respectively) and the lymphocyte counts were significantly lower than thosebefore operation (P< 0.05, respectively); The neutrophil count, neutrophil count/lymphocyte count ratio peaked on day 1 after operation, and lymphocyte count at day 1 after surgery decreased to a minimum; The levels of neutrophil count and neutrophil count/lymphocyte count ratio in the laparoscopic group were lower than those in the laparotomy group at day 1, 2, 3, 7 after operation, while the level of lymphocyte count was higher (P< 0.05, respectively). Conclusion Compared with open surgery, laparoscopic surgery has less bleeding with the same effect and longer operative time. The acute phase reaction and the degree of cellular immunosuppression are less than those of open surgery, probably due to the smaller trauma and internal environment interference of the laparoscopic surgery.

     

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