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1、上海交通大学医学院硕士学位论文计学意义；切口旁与远离切口在三个时间点上比较均无统计学意义；对照肌瘤组各时间点的比较无统计学意义（P>0.05）。各种恶性肿瘤在各时间点和腹膜不同取材部位TNF-α的表达与其在恶性肿瘤总体中的表达规律相同,而腹膜TNF-α的表达在三种性质肿瘤间的比较无统计学意义（P>0.05）。结论TNF-α是腹膜有效的抗肿瘤免疫因子；腹腔镜手术与开腹手术中随着时间的延长，TNF-α的表达下降，腹膜局部免疫功能下降，且腹腔镜手术中TNF-α表达的下降更为显著。说明CO2气腹损伤腹膜免疫，可能促进恶性肿瘤的转
2、移。腹腔镜组切口旁的TNF-α表达较远离切口处高，提示可能切口处局部免疫功能较强。关键词TNF-α，恶性肿瘤，腹腔镜手术，CO2气腹上海交通大学医学院硕士学位论文THEEXPRESSIONOFTNF-αINTHEPERITONEUMFROMHUMANWITHCANCERGYNECOLOGICALTREATEDBYLAPAROSCOPICOPERATIONABSTRACTObjectThelaparoscopicapproachtosurgeryofthealimentarytractisnowwellacceptedfo
3、rappropriateprocedures.Patientsundergoingminimallyinvasiveabdominalsurgerybenefitfromlesspostoperativepain,shorterpostoperativeileus,shorterhospitalstays,amorerapidreturntopreoperativeactivity,andsuperiorcosmesiscomparedwiththeirlaparotomizedcounterparts.Material
4、sandmethodsFromSeptember2006toSeptember2008，60women,weredividedinto4groups:25women,withcancer(tumormalignantincludingcancerofthecervix,ovariancancer,endometrialcancer),treatedbylaparoscopicapproach,15womenwithcancer(tumormalignantincludingcancerofthecervix,ovaria
5、ncancer,endometrialcancer),treatedbyopenoperation,10上海交通大学医学院硕士学位论文womenwithhysteromyomatreatedbylaparoscopicapproach,10womenwithhysteromyomatreatedbyopenoperation.ResultsTheexpressionofTNF-αintheperitoneuminthetumormalignantgroupsisobviouslyhigherthanthatofthehy
6、steromyomagroup(P<0.05).TheexpressionofTNF-αinlaparoscopicgroupweresignificantlylowerthanthatinopengroup(P<0.05).Inlaparoscopictumormalignantgroup,theexpressionofTNF-αnearportsite/incisionweresignificantlyhigherthanthatfarawayfromportsite/incision(P<0.05),Compari
7、sonoftheexpressionofTNF-αatvarioustimepointsandpositionsshowednodifferences(P>0.05).Inopengroup,therewerenosignificantdifferenceoftheexpressionofTNF-αatvarioustimepointsandpositive.ConclusionsCarbondioxidepneumoperitoneumusedinlaparoscopicsurgerydepresstheexpress
8、ionofTNF-αofperitonealmesothelialcellsascomparedwiththatofopensurgery,whichsuggestedthatcarbondioxidepneumoperitoneummayincreasetheriskoftumorspreadinlaparosco
