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目的探讨腹腔镜手术对中低位直肠癌患者免疫功能和切口感染的影响。方法前瞻性纳入笔者所在医院科室2008年9月至2013年3月期间收治的中低位直肠癌患者,根据纳入及排除标准共有128例纳入研究,采用数字表法将纳入研究患者随机分为腹腔镜手术组与开腹手术组,2组各64例。检测2组患者术前1 d及术后3 d的免疫功能指标,并统计切口感染率。结果术前1 d,2组患者外周血CD3+、CD4+、CD8+及CD4+/CD8+的差异均无统计学意义(P>0.05);术后3 d,开腹手术组的CD3+及CD4+/CD8+较术前均有明显降低(P<0.05),而腹腔镜手术组术后3 d的CD3+及CD4+/CD8+下降不明显,并高于开腹手术组(P<0.05)。开腹手术组术后3 d血清Ig G、Ig A、Ig M及Ig E水平较术前均明显降低(P<0.05),而腹腔镜手术组术后3 d血清Ig G、Ig A、Ig M及Ig E水平与术前比较变化不明显(P>0.05),且均高于开腹手术组(P<0.05)。术后切口感染发生率开腹手术组为17.2%(11/64),腹腔镜手术组为7.8%(5/64),后者低于前者(P<0.05)。结论腹腔镜手术治疗中低位直肠癌对患者免疫功能影响小,切口感染率低。
Objective To investigate the effect of laparoscopic surgery on immune function and incision infection in patients with low or middle rectal cancer. Methods Prospectively included in our hospital department from September 2008 to March 2013 in the treatment of patients with low rectal cancer, according to the inclusion and exclusion criteria a total of 128 cases included in the study, the use of digital table included in the study were randomly divided into laparoscopic Surgical group and open surgery group, two groups of 64 cases. The immune function indexes of the two groups before operation and 3 days after operation were detected, and the incision infection rate was calculated. Results There was no significant difference in the levels of CD3 +, CD4 +, CD8 + and CD4 + / CD8 + between the two groups before operation on the 1st day before operation (P> 0.05). On the 3rd day after operation, CD3 + and CD4 + / CD8 + (P <0.05). However, the levels of CD3 + and CD4 + / CD8 + in laparoscopic surgery group after 3 days of operation were not significantly lower than those of laparotomy group (P <0.05). Serum levels of Ig G, Ig A, Ig M and Ig E in the laparotomy group were significantly decreased 3 days after operation (P <0.05), while serum levels of Ig G, Ig A, Ig The levels of M and Ig E were not significantly different from preoperation (P> 0.05), and were significantly higher than those in open surgery group (P <0.05). Incision infection rate was 17.2% (11/64) in open surgery group and 7.8% (5/64) in laparoscopic surgery group, while the latter was lower than the former (P <0.05). Conclusions Laparoscopic surgery for low and middle rectal cancer has little effect on immune function and incision infection rate is low.