Effects Of Laparoscopic Hepatectomy For Liver Cancer On Cellular Immune Function In Patients

Objective:To compare prospectively effects of laparoscopic hepatectomy(LH) and open hepatectomy(OH) for liver cancer on cellular immune function in selected patients with primary hepatocellular carcinoma(PHCC), evaluate the immunosuppression cause by patients' traumatic reaction after LH, and encourage the development of LH for the PHCC and other malignant tumor treated by complicated pelviscopy。Methods:60 selected patients with PHCC were randomly divided into LH and OH group, and total 6 cases were eliminated according to our protocol. Data of 27 LH and 27 OH were studied and analyzed and there were no differences on statistics between them on the sexuality, age, tumor size.Data of patients were recorded, including length of incision, surgical duration, anaesthetic duration, porta-hepatis blockage duration, modus operandi, intraoperative blood loss, pathologic diagnosis,tumor location, tumor size, hospital stay, complications, et al. All patients' peripheral blood was sampled to measure liver function and cell-mediated-immunologic markers (LCC, MCC, CD3~+, CD4~+, CD8~+, CD4~+/CD8~+, NK, FasL, CD3~+PFP~+, CD3~+GrB~+) before operation and on the morning of the 1st, 4rd,7th day after operation. SPSS13.0 was used for statistical analysis.Results:The average length of incision in LH group was shorter than that in OH group. Intraoperative blood loss and surgical duration had no statistical significance between the two groups. Postoperative time in LH group was decreased compared with OH group(P<0.05). LH after one day began to get out of bed activities, and OH was the first three days. No pleural effusion occurred in LH group, but pleural effusion, bile leakage and infection of incisional wound occurred in OH group. ALT, AST and TBIL increased in both groups on the 1th day after operation and recovered on the 7th day after operation, and there was no statistical significance between two groups.In both groups, level of cell-mediated-immunologic markers(LCC, CD3~+, CD4~+, CD8~+, CD4~+/CD8~+, NK, CD3~+PFP~+, CD3~+GrB~+) decreased while level of MCC, FasL increased compared with the preoperative level (P<0.05), which recovered gradually. The decreased level and speed in LH group were less than that in OH group with statistical significance for CD3~+, CD8~+, CD4~+/CD8~+, NK, CD3~+PFP~+, CD3~+GrB~+. The level of LCC and CD4~+ after LH was no statistical significance between LH and OH(P>0.05). MCC and FasL were greater in OH group compared with LH group (P<0.05).Conclusions:LH results in the suppression on cell mediated immunity of patients with PHCC, but it is less compared with OH. LH is feasible and safe in selected patients with PHCC.