| Objective: Surgical trauma may cause the change of organism in physiology and immune function . The extent of surgical trauma significantly affect the level of inflammatory during earlier period . Traditional operation on abdominal region can influence the defense function of organism accordingly to causeing the decent of immune function.Accompanied with the widespread use of abdominal speculum in rectal cancer , it is important to evaluate the effect on inflammatory reaction .To study the alterations of immune function afer laparoscopic and open operation in patients with rectal cancer.Methods:Forty seven patients with rectal cancer were divided into laparoscopic group (with 23 patients) and open operation group (with 24 patients) from May 2007 to January 2008. C-reactive protein(CRP), IgG, IgA, IgM, C3, C4, CRP, CD4, CD8, CD3, CD56,CD4/CD8 in peripheral blood were assayed at 1 day before operation, 1 day and 5 day after operation to compare with two group of patient's immunity targets and observe in the near future clinical curative effect.ResultsForty seven patients with rectal cancer resection were all completed successfully and there was no conversion to an open approach in laparoscopic group.1 Serum IgG,C3,C4There is no significant difference between the patients with preoperative serum IgG,C3,C4 in two groups (P> 0.05) .1.1 the first day of postoperative IgG, C3, C4The total variation tendency of the patients in two groups is the same after operation, there is obviously descent after operation in them.On the first day of post operation the level of IgG, C3, C4, decreased significantly (P<0.01) than the preoperative ones. The C4 levels of patients in two groups in the first days after operation have significant differences. After a statistical analysis it indicates that there is a statistical significance (P<0.05), that is the content of C4 of open group was significantly lower than the laparoscopic group and it makes greater impact on the body.1.2 the fifth day of postoperative IgG, C3, C4On the fifth day of post operation, the contents of C3, C4 back to the preoperative level. Compared with the preoperative levels, it has no significant difference (P>0.05) in the two groups. Serum IgG in both groups is still lower than the preoperative level, and it indicates significant differences (P<0.05) between the fifth day post and before operation, but the comparison between the two surgical groups had no significant difference (P>0.05).2 Serum IgA,IgMThe preoperative serum IgA,IgM of patients in two groups showed no significant difference (P>0.05). On the first day, the postoperative leves of serum IgA,IgM were significantly decreased when it compared with preoperative Serum IgA,IgM (P<0.01) . Compared between the two groups, there was no significant difference on the first day of postoperative serum IgA,IgM (P>0.05). On the fifth day of post operation, serum IgA level of the two groups was still significantly lower than the preoperative level (P <0.01), and the laparoscopic surgery patients serum IgA level higher than the open group. Statistical analysis indicates that there is a statistical significance (P<0.01), that is the Laparoscopic Surgery has minor effect on the level of serum IgA. After five days of Laparoscopic Surgery, the patient's serum IgM level showed no significant difference (P>0.05), but the open group's serum IgM level was significantly lower than the preoperative level. Statistical analysis indicates that there is a statistical significance (P<0.01), that is the Laparoscopic Surgery patients'serum IgM level was higher than the open group ones', so we can draw a conclusion that Laparoscopic Surgery has minor effect on the serum IgM level than open operation.3 serum CRPAs a fact that the two groups preoperative serum CRP were still within the reference number(0～15mg/L). The concentration of CRP had a rapid increase after the operation and reached the peak point at the first day after operation, and then it began to decline, but to the fifth day after operation, The CRP of patients in two groups were significantly higher than the preoperative level. Statistical analysis indicates that there is a statistical significance (P<0.01).Compared between the two groups, the Laparoscopic group has a greater degree of decline on CRP than the open group. Statistical analysis indicates that there is a statistical significance (P<0.05).4 serum CD4,CD8,CD4/CD8,CD3,CD564.1 the assaying and analytic results of serum CD4,CD8,CD4/CD8,CD3,CD56 in the first day after operationThere is no significant difference on the preoperative serum CD4,CD8,CD4/CD8,CD3,CD56 between the two groups. On the first day, the postoperative serum CD4,CD8,CD3 were significantly decreased when it compared with preoperative numbers. Statistical analysis indicates that there is a statistical significance (P<0.01), and there is no significant difference between the two groups(P>0.05).On the first day, the postoperative CD56 has no significant decline when it compared with preoperative content (P<0.01), and there was no significant difference between the two groups. Therefore we can say that the two methods have the same effect on the level of CD56.For the serum CD4/CD8, the Laparoscopic patients have no difference between the first day of post operation and preoperative time, so it has no statistical significance (P>0.05), but the open group patients has significant decline (P<0.05), and it has statistical significance. Now we can draw a conclusion that Laparoscopic Surgery can make smaller effect on serum CD4/CD8 than open operation.4.2 the assaying and analytic results of serum CD4,CD8,CD4/CD8,CD3,CD56 in the fifth day after operation On the fifth day, the postoperative CD4 has significant decline when it compared with preoperative content, and it has statistical significance (P<0.05). The open group has greater degree of decline, and it has statistical significance (P<0.05). We can draw a conclusion that Laparoscopic Surgery can make smaller effect on serum CD4 than open operation.After five days of laparoscopic surgery, the level of serum CD3,CD8 has increased to the preoperative level, but for the open group patients it has a little decline when it compared with the preoperative level. So we can say that Laparoscopic Surgery can make smaller effect on serum CD3,CD8 than open operation.On the fifth day, the postoperative serum CD56 has significant decline when it compared with preoperative content, and it has statistical significance (P<0.05), and there is no difference between the two groups. So the two operation methods have same effect on the level of serum CD56.The postoperative serum CD4/CD8 level has no significant decline, and it has no statistical significance (P<0.05). Between the two groups, the serum CD4/CD8 level are quite similar (P>0.05). So the two operation methods have same effect on the level of serum CD4/CD8. 5 The operative blood loss in laparoscopic group was significantly lower than that in open group(P<0.05).In laparoscopic group, the intestinal function recovery time and evacuation time were significantly shortened. The difference was significant when compared with the open group(P<0.05). There was no significant difference between the two groups in operative time and complication.Conclusion: The patients of laparoscopic rectal carcinoma surgery bleed a little , recover quickly in terms of stomach affection and stay in hospital for a shorter time , which demonstrates good efficiency of social and economy . Laparoscopic operation has less effect on immune function in patients with rectal cancer than traditional open surgery. Laparoscopic rectal cancer surgery is a kind of safe, minimally insult, rapid recovery operation.
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