论文部分内容阅读
目的从腹膜免疫因子变迁探讨腹腔镜手术治疗妇科恶性肿瘤对患者免疫功能的影响。方法选取本院收治的妇科恶性肿瘤患者49例,随机分为腔镜组25例和开腹组24例,腔镜组行腹腔腹微创手术,开腹组行传统开腹术,术后取患者腹膜组织,采用ELISA试剂盒测定免疫因子IL-1、TNF-α和IL-6质量浓度;并分别于术前1 d、术后1 d、术后1周取患者空腹静脉血,采用流式细胞术测定T淋巴细胞亚群T、Th、Ts、Th/Ts及调节性T细胞CD4+CD25highCD127lowTreg水平,衡量患者手术前后的免疫功能状态。结果腹膜组织:腔镜组患者腹膜组织的IL-1、TNF-α和IL-6含量均显著低于开腹组(P<0.05)。外周血:术前1 d,2组患者的T淋巴细胞及调节性T细胞水平无显著差异(P>0.05);术后1 d,腔镜组患者外周血T、Th及Th/Ts水平均显著低于开腹组(P<0.05);CD4+CD25highCD127lowTreg水平显著高于开腹组(P<0.05),2组间Ts水平无显著差异(P>0.05);术后7 d,2组患者的T淋巴细胞及调节性T细胞水平均无显著差异(P>0.05)。结论腹腔镜手术在建立CO2气腹的过程中,可对分泌型免疫因子IL-1、TNF-α和IL-6产生抑制作用,从而削弱患者的免疫功能;然而该抑制作用为短期效应,可随术后时间的延长得以恢复。
Objective To investigate the effect of laparoscopic surgery on immune function in patients with gynecological malignancies from the changes of peritoneal immune factors. Methods Forty-nine patients with gynecological malignant tumor admitted to our hospital were randomly divided into 25 cases of laparoscopic group and 24 cases of laparotomy group. Laparoscopic minimally invasive surgery was performed in laparoscopic group. Conventional laparotomy was performed in laparotomy group. The levels of IL-1, TNF-α and IL-6 in the peritoneum of the patients were measured by ELISA kit. Fasting venous blood was collected on the first day before operation, one day after operation and one week after operation. The levels of T, Th, Ts, Th / Ts and CD4 + CD25highCD127lowTreg in T lymphocyte subsets were determined by the cytometry, and the immune function was measured before and after the operation. Results Peritoneal tissue: The content of IL-1, TNF-α and IL-6 in the peritoneal cavity of the endoscopic group was significantly lower than that of the laparotomy group (P <0.05). Peripheral blood: The levels of T lymphocytes and regulatory T cells in two groups had no significant difference (P> 0.05) on the first day before operation. The level of T, Th and Th / Ts in peripheral blood of patients in the endoscopic group were (P <0.05). The levels of CD4 + CD25highCD127lowTreg were significantly higher in the open group than those in the open group (P <0.05). There was no significant difference in Ts between the two groups (P> 0.05) Of T lymphocytes and regulatory T cells were no significant difference (P> 0.05). Conclusions Laparoscopic surgery can inhibit the secretory immune factors IL-1, TNF-α and IL-6 in the process of CO2 pneumoperitoneum, thus weakening the immune function of patients. However, this inhibition is a short-term effect With the extension of postoperative time to be restored.