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目的探讨腹腔镜与开腹肝癌切除术对患者临床康复和体液免疫功能的影响。方法选取2010年1月至2012年6月期间徐州医学院附属医院、江苏省肿瘤医院及南京中医药大学第二附属医院行腹腔镜及开腹肝癌左外叶切除术患者44例,其中腹腔镜组22例,常规开腹组22例。采用ELISA法测定患者术前1 d以及术后第l天和第5天外周血中IgG、IgA、IgM、C3、C4、C反应蛋白(CRP)、IL-2、IL-6及TNF-α水平的变化,同时比较2组患者的手术时间、术中出血量、住院时间及并发症发生情况。结果腹腔镜组患者术后镇痛剂使用时间为(1.9±0.8)d,首次进食时间为(2.2±0.5)d,住院时间为(6.3±1.3)d,均短于开腹组(P<0.05),但2组间的手术时间、术中失血量、并发症发生率及死亡率差异均无统计学意义(P>0.05)。与术前相比,术后第1天2组患者的C3、C4、lgA、IgG、lgM和IL-2均明显降低(P<0.05),CRP、IL-6及TNF-α均明显升高(P<0.05);开腹组患者术后第l天的C3、C4、lgA、IgG、lgM和IL-2的下降幅度较腹腔镜组更明显(P<0.05)。术后第5天,腹腔镜组患者的C3、C4、lgA、IgG、lgM及IL-2水平上升和CRP、IL-6及TNF-α水平下降并均接近术前水平;而开腹组患者的C3、C4、lgA、IgG、lgM及IL-2仍低于术前水平(P<0.05),CRP、IL-6及TNF-α仍仍高于术前水平(P<0.05)。结论腹腔镜肝癌切除术后患者的恢复较快,且对患者机体体液免疫功能的影响小于开腹肝癌切除术。
Objective To investigate the effect of laparoscopic and open hepatectomy on clinical rehabilitation and humoral immune function. Methods From January 2010 to June 2012, Xuzhou Medical College Hospital, Jiangsu Provincial Tumor Hospital and the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2010 to June 2012 were divided into two groups: 44 cases of laparoscopic and open hepatic lobectomy, Group 22 cases, conventional open group of 22 cases. Serum levels of IgG, IgA, IgM, C3, C4, C-reactive protein (CRP), IL-2, IL-6 and TNF-α in peripheral blood were measured by ELISA on day 1 before operation and on days 1 and 5 Level changes, while comparing the two groups of patients operating time, intraoperative blood loss, hospital stay and complications. Results The duration of postoperative analgesics in laparoscopic group was (1.9 ± 0.8) days, the time to first meal was (2.2 ± 0.5) days and the length of stay in hospital was (6.3 ± 1.3) days, both of which were shorter than that of laparotomy group (P < 0.05). However, there was no significant difference in operative time, intraoperative blood loss, complication rate and mortality between the two groups (P> 0.05). Compared with preoperative, the levels of C3, C4, lgA, IgG, lgM and IL-2 in the two groups were significantly decreased (P <0.05) and the levels of CRP, IL-6 and TNF- (P <0.05). The decrease of C3, C4, lgA, IgG, lgM and IL-2 on the first postoperative day in the open group was more significant than that in the laparoscopic group (P <0.05). The levels of C3, C4, lgA, IgG, lgM and IL-2 in the laparoscopic group decreased and the levels of CRP, IL-6 and TNF-α decreased in the laparoscopic group on day 5 postoperatively, C3, C4, lgA, IgG, lgM and IL-2 were still lower than preoperative levels (P <0.05). CRP, IL-6 and TNF-α were still higher than preoperative levels (P <0.05). Conclusions The recovery of patients after laparoscopic resection of liver cancer is rapid, and the influence on humoral immune function in patients is less than that of open hepatectomy.