CAJ | 학술논문

目的：探讨腹腔镜与开腹肝癌左外叶切除术对患者临床康复和机体免疫功能的影响。方法选取2010年1月至2012年6月期间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，开腹组22例。采用流式细胞仪测定患者术前1d、术后第l天和第5天外周血中CD3、CD4/CD8、CDl9及NK细胞比例（数）的变化，ELISA测定外周血中CRP、IL-1β、IL-8、TNF-α的变化，研究不同手术方式对患者免疫功能的影响。同时比较两组的手术时间、术中出血量、住院天数、并发症等。结果腹腔镜组术后患者平均镇痛剂使用时间为（1.9±0.8）d，平均首次进食时间为（2.2±0.5）d，平均住院时间为（6.3±1.3）d，均优于开腹组（P<0.05）。两组手术时间、术中失血量、并发症及死亡率差异无统计学意义。与术前1d相比，术后1dCD3、CD19、CD4/CD8、NK细胞和IL-2都显著性降低，而CRP、IL-1β、IL-8、TNF-α显著性升高。开腹组术后ldCD3、CD19、CD4/CD8、NK细胞下降比腹腔镜组更加明显，而CRP、IL-1β、IL-8、TNF-α显著性升高。术后5d腹腔镜组CD3、CD4/CD8、CDl9及NK、CRP、IL-1β、IL-8、TNF-α的恢复和术前已经没有差别，而开腹组CD3、CD19、CD4/CD8、NK仍然处于低水平状态和术前相比明显下降，CRP、IL-1β、IL-8、TNF-α处于显著性升高水平。结论腹腔镜组患者恢复快且对患者机体免疫功能的影响明显小于开腹组手术。
목적：탐토복강경여개복간암좌외협절제술대환자림상강복화궤체면역공능적영향。방법선취2010년1월지2012년6월기간행복강경급개복간암좌외협절제술환자44례，기중복강경조22례，개복조22례。채용류식세포의측정환자술전1d、술후제l천화제5천외주혈중CD3、CD4/CD8、CDl9급NK세포비례（수）적변화，ELISA측정외주혈중CRP、IL-1β、IL-8、TNF-α적변화，연구불동수술방식대환자면역공능적영향。동시비교량조적수술시간、술중출혈량、주원천수、병발증등。결과복강경조술후환자평균진통제사용시간위（1.9±0.8）d，평균수차진식시간위（2.2±0.5）d，평균주원시간위（6.3±1.3）d，균우우개복조（P<0.05）。량조수술시간、술중실혈량、병발증급사망솔차이무통계학의의。여술전1d상비，술후1dCD3、CD19、CD4/CD8、NK세포화IL-2도현저성강저，이CRP、IL-1β、IL-8、TNF-α현저성승고。개복조술후ldCD3、CD19、CD4/CD8、NK세포하강비복강경조경가명현，이CRP、IL-1β、IL-8、TNF-α현저성승고。술후5d복강경조CD3、CD4/CD8、CDl9급NK、CRP、IL-1β、IL-8、TNF-α적회복화술전이경몰유차별，이개복조CD3、CD19、CD4/CD8、NK잉연처우저수평상태화술전상비명현하강，CRP、IL-1β、IL-8、TNF-α처우현저성승고수평。결론복강경조환자회복쾌차대환자궤체면역공능적영향명현소우개복조수술。
Objective To investigate the impact of laparoscopic vs open left -lateral radical sectionectomy for hepatocellular carcinoma on immune function and clinical rehabilitation in patients organism. Methods Select from January 2010 to June 2012, 44 patients of laparoscopic and open left-lateral radical hepatocellular carcinoma sectionectomy, including 22 patients of laparoscopic group and 22 patients of laparotomy group. Using flow cytometry measure the change of CD3 , CD4/CD8, CD19 and the proportion(number) of NK cells in peripheral blood in patients on the first day and 5th day after operation Using ELISA measure the change of CRP、IL-1β、IL-8、TNF-α in peripheral blood, studying the effects of different operative methods on immune function in patients organism. At the same time,comparing between two groups of operative time, intraoperative blood loss, hospital days, complications, and so on. Results The laparoscopic group average postoperative analgesic use time were (1.9±0.8) days , and the average for the first time eating were (2.2±0.5) days , and the average length of stay were (6.3±1.3) days, better than open surgery group (P<0.05). Compared with the difference of the two groups of operative time, intraoperative blood loss, complications and mortality were not statistically significant. Compared with before operation,the two groups CD3、CD19、CD4/CD8、NK are significantly reduced , CRP、IL-1β、IL-8、TNF-α are significantly increased on the first day after operation. CD3, CD19, CD4/CD8, NK cells of the laparotomy group on the first day after operation are significantly reduced. than the laparoscopic group. However,CRP、IL -1β、IL -8 and TNF -α was significantly increased. Compared with before operation, there is no difference on recovery of CD3、CD4/CD8、CDl9、 NK、CRP、CRP、IL-1β、IL-8、TNF-α of the laparoscopy group on the 5th day after operation. However, CD3、CD19、CD4、CD8、NK of the control group are still at a low level state and significantly reduced than before operation, CRP、IL-1β、IL-8、TNF-α at a high level state on the 5th day after operation.Conclusions The laparoscopic group patients recover quickly and the impact of laparoscopic radical resection was significantly less than laparotomy for hepatocellular carcinoma on immune function in patients organism.