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目的比较全身麻醉下内镜和传统直肠癌切除术对机体免疫功能的影响。方法30例45～76岁拟行直肠癌切除术的患者,随机将患者分为内镜直肠癌切除术(ESRRC)组和传统直肠癌切除术(ORRC)组,各组各15例。于术前、术后24h、术后72h采集外周静脉血样,采用ELISA法测定IL-6、TNF-α浓度;采用流式细胞仪测定CD3、CD4、CD8表达,计算CD4/CD8;采用免疫比浊法测定血清免疫球蛋白IgG、IgM、IgA、CRP浓度。结果两组患者术后24h血清IL-6明显高于术前(P<0.05),但72h后基本回到术前水平。两组患者围术期各时点PBL亚群均无明显改变,组间各对应时点比较差异亦无统计学意义。术后24h血清IgG均有下降(P<0.01),但ORRC组下降较ESRRC组明显(P<0.05),且持续72h以上。术后48h内,CRP组较术前明显升高(P<0.01),且两组比较ORRC组明显高于ESRRC组(P<0.01)。结论与ORRC相比,ESRRC对机体细胞因子水平及免疫功能的不利影响较小,有利于病人恢复。
Objective To compare the effects of endoscopic and traditional resection of colorectal cancer on immune function under general anesthesia. Methods Thirty patients (45-76 years old) scheduled for resection of the rectal cancer were randomly divided into two groups: the endoscopic rectal cancer resection (ESRRC) group and the traditional rectal cancer resection (ORRC) group, with 15 cases in each group. Peripheral venous blood samples were collected before operation, 24h after operation and 72h after operation. The concentrations of IL-6 and TNF-α were measured by ELISA. The expressions of CD3, CD4 and CD8 were measured by flow cytometry and the ratio of CD4 / CD8 was calculated. Turbidimetric determination of serum immunoglobulin IgG, IgM, IgA, CRP concentrations. Results Serum IL-6 levels of patients in both groups were significantly higher than those before operation (P <0.05), but returned to preoperative levels after 72 hours. There was no significant difference in PBL subpopulation between the two groups at all time points, and there was no significant difference between the two groups in response time. Serum IgG decreased after operation (P <0.01), but decreased in ORRC group than that in ESRRC group (P <0.05), and lasted for more than 72 hours. Within 48 hours after operation, CRP group was significantly higher than that before operation (P <0.01), and the ORRC group was significantly higher than ESRRC group (P <0.01). Conclusion Compared with ORRC, ESRRC has little adverse effect on cytokine levels and immune function, which is beneficial to patient recovery.