摘要
目的比较腹腔镜直肠癌切除术(laparoscopic rectal cancer surgery,LRS)与开腹直肠癌切除术(open rectal cancer surgery,ORS)对机体免疫功能的影响。方法计算机检索PubMed、Cochrane图书馆、中国期刊全文数据库、万方数据库、中文科技期刊全文数据库、中国生物医学文献数据库,纳入有关比较LRS与ORS对机体免疫功能影响的随机对照试验和前瞻性队列研究,对纳入文献的质量进行评价,并对相关指标进行Meta分析。结果共纳入10个随机对照试验和9个前瞻性队列研究,共1110例患者,其中LRS组552例,ORS组558例。Meta分析结果显示:在术后的1d、3d、7d,LRS组的CD4+T淋巴细胞、NK细胞均高于ORS组(均P<0.05),但两组的CD8+T淋巴细胞无明显差别(均P>0.05)。术后1d,两组的CD4+/CD8+比值无明显差别(P>0.05);术后3d、7d,LRS组的CD4+/CD8+比值高于ORS组(均P<0.05)。两组的IgG和IgM在术后1d无明显差别(均P>0.05),但LRS组术后1d的IgA高于ORS组。此外,LRS组术后1d、3d的白细胞介素-6水平小于ORS组(均P<0.05)。结论与ORS相比,LRS对机体细胞免疫功能的抑制较小,但由于纳入研究的质量不高,期待高质量、大样本、多中心的随机对照试验来进一步验证。
Objective To compare the impacts of immune function between patients treated with laparoscopic rectal cancer surgery（LRS）or open rectal cancer surgery（ORS）.Methods The Medline,Cochrane Library,CNKI,Wanfang Database,VIP,CBM Disc were searched electronically.Randomized controlled trials or prospective cohort studies comparing the impacts of immune function between patients treated with LRS or ORS were collected,and Meta-analysis was performed to evaluate related parameters.Results Ten randomized controlled trials and nine prospective cohort studies involving 1110 patients were included,with552 patients in LRS group and 558 patients in ORS group.Meta-analysis showed that the levels of CD4＋T lymphocytes and natural killer cells in LRS group were significantly higher than those in ORS group on postoperative day 1,3and 7（all P〈0.05）,however,no significant differences were found in CD8＋T lymphocytes between the two groups（P〉0.05）.LRS group had significantly higher ratio of CD4＋/CD8＋than ORS group on postoperative day 3and 7（all P〈0.05）,but not on postoperative day 1.On the postoperative day 1,the levels of IgG and IgM between the two groups showed no significant difference（all P〉0.05）,nevertheless,the level of IgA in LRS group was significantly higher than ORS group（P〈0.05）.Additionally,LRS group had a significantly lower level of interleukin-6than ORS group both on postoperative day 1and 3（all P〈0.05）.Conclusion Compared with ORS,LRS exerts a less negative impacts on the cellular immunity of patients with rectal cancer.Nevertheless,with the poor quality of included studies,further high-quality,large-size,multi-center randomized trials are needed to confirm our conclusions.
出处
《结直肠肛门外科》
2015年第3期200-208,共9页
Journal of Colorectal & Anal Surgery
基金
防城港市科学研究与技术开发计划课题(防科攻1102001)
关键词
直肠癌
腹腔镜
免疫
META分析
Rectal neoplasms
Laparoscopy
Immunity
Meta-analysis
