腹腔镜与开腹宫颈癌根治术对机体细胞免疫影响的对比研究*

Comparative study of laparoscopic and transabdominal radical hysterectomy's impact on the cellular immunity*

摘要:

 目的  对比研究腹腔镜及传统开腹宫颈癌根治术对早期宫颈癌患者细胞免疫的影响。方法   收集昆明医科大学第三附属医院妇科早期（Ⅰa2～Ⅱa1期）宫颈癌患者60例，开腹组、腹腔镜组各30例。采用流式细胞术检测患者手术前1天、术后1天、术后5天及术后28天外周血中T淋巴细胞亚群、自然杀伤细胞（NK）、多种细胞因子诱导的杀伤细胞（CIK）和T淋巴细胞活化功能，比较两组手术前后免疫指标的变化。结果   ①术后1天两组患者T淋巴细胞亚群数量较术前1天下降（P <0.05），术后5天各指标较术后1天有所升高，腹腔镜组下降程度小于开腹组（P <0.05），且恢复快；②术后1天两组患者外周血人白细胞抗原（HLA）-DR+CD3+数量较术前下降，HLA-DR+CD8+较术前升高，腹腔镜组变化程度小，在术后5天恢复快。结论   腹腔镜组术后免疫功能变化幅度小，恢复快，对患者免疫功能抑制程度轻，可能更好地保护了患者的免疫功能。

Abstract:

 Objective To compare the difference of impact on the cellular immunity between laparoscopic and transabdominal radical hysterectomy. Methods 60 patients with early cervical cancer (Ⅰa2～Ⅱa1), half of them were assigned to do abdominal radical hysterectomy (ARH) and the other half for laparoscopic radical hysterectomy (LRH). Adopt flow cytometry (FCM) detect peripheral blood T lymphocyte subsets, NK cells, CIK cells and T lymphocyte activation function on one day before surgery, one day, five days, and 28 days after the surgery separately. Compare the changes of immune status. Results After one day, the number of T lymphocyte subsets declined compared with preoperative one day(P < 0.05). After five days, each index in LRH group was increased compared with postoperative one day, and the degree of decline is less than the ARH group (P < 0.05), and recovered faster. After one day, the number of HLA-DR+CD3+ in LRH group compared with the preoperative one day declined and HLA-DR+CD8+ increased, and the degree of change is less than the ARH group, and recovered faster. Conclusions Immune function in patients after laparoscopic group was less changed, and recovered quickly, while the immune function were less inhibited, it may protect patients' immune function better.