대장암의 개복수술 및 복강경수술에 대한 면역학적 비교
Comparative Evaluation of Immune Responses after Laparoscopic and Open Surgery in Patients with Colorectal Cancer
이인택, 최규석, Liu Weidong, 원동일, 조민정, 전수한,
소속 상세정보
이인택 ( Lee In-Taek )
경북대학교 의과대학 외과학교실
최규석 ( Choi Gyu-Seog )
경북대학교 의과대학 외과학교실
( Liu Weidong )
경북대학교병원 생명의학연구소
원동일 ( Won Dong-Il )
경북대학교 의과대학 진단검사의학교실
조민정 ( Jo Min-Jung )
경북대학교 의과대학 외과학교실
전수한 ( Jun Soo-Han )
경북대학교 의과대학 외과학교실
KMID : 0356720060220050314
Abstract
Purpose: The laparoscopic approach is thought to reduce postoperative immunologic and metabolic effects after surgery compared to the open approach. This study was designed to compare the systemic immune and metabolic responses after laparoscopic and open surgery in patients with colorectal cancer.
Methods: Forty-four patients with colorectal cancer were prospectively assigned to undergo either a laparoscopic (n=22) or open (n=22) approach. The postoperative immune and metabolic responses were assessed by measuring the serum level of the relative proportion of lymphocytes, the T-cell count, the natural killer cell (NK-cell) count, the human leukocyte antigen-DR (HLA-DR) expression on monocytes, the interleukin-6 (IL-6), and the C-reactive protein (CRP) at specific time intervals.
Results: Both approaches resulted in a significant decrease in lymphocyte count, T-cell count, NK-cell count, and HLA- DR expression on monocytes at 2, 24, and 72 hours postoperatively. However, the decrease in HLA-DR expression on monocytes was more significant in open surgery at 2 hour postoperatively (mean level, laparoscopic: 90.9% vs. open: 83.1%, P＜0.001). Significant rises in IL-6 and CRP were demonstrated within 72 hour postoperatively in both groups. However, no significant difference between the two groups was seen.
Conclusions: Although both laparoscopic and open surgery in patients with colorectal cancer evoked an alteration of the systemic inflammatory and immune response, our data showed that a HLA-DR expression on monocytes may be less compromised after laparoscopic approach for an immediate postoperative period. However, clearer evidence from large-scaled prospective randomized trials are needed. J Korean Soc Coloproctol 2006;22:314-321
키워드
면역 반응;복강경 수술;대장암
Immune response;Laparoscopic surgery;Colorectal cancer
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