腹腔镜辅助结直肠癌根治术治疗结直肠癌的疗效及对患者营养水平、机体免疫状态的影响
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摘要
目的观察腹腔镜辅助结直肠癌根治术对结直肠癌患者的临床疗效,分析结直肠癌患者手术前后营养水平与机体免疫状态的变化情况。方法回顾性分析92例结直肠癌患者的临床资料,根据手术方法的不同将患者分为研究组与对照组,每组46例。研究组患者行腹腔镜辅助结直肠癌根治术,对照组患者行常规开腹手术。观察两组患者的围手术期指标(手术时间、术中出血量、术后排气时间、术后住院时间),采用免疫混悬计检测法检测两组患者的术后机体免疫指标[自然杀伤(NK)细胞、C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]和营养指标[白蛋白(ALB)、血红蛋白(Hb)、转铁蛋白(TRF)、前白蛋白(PRE)、视黄醇结合蛋白(RBP)]。结果研究组患者的术中出血量明显低于对照组患者,术后排气时间和术后住院时间均明显短于对照组患者,手术时间明显长于对照组患者(P﹤0.01)。术后7天,对照组患者的ALB、Hb、TRF、PRE、RBP水平均低于研究组患者(P﹤0.05)。术后7天,研究组患者的CRP、IL-6和TNF-α水平均明显低于对照组患者,NK细胞水平明显高于对照组患者(P﹤0.01)。结论临床中对结直肠癌患者实施腹腔镜手术治疗是可行的,腹腔镜手术对患者机体免疫力的影响较小,且能够促进患者术后机体的恢复,改善患者术后的营养水平,值得临床推广应用。
Objective To observe the clinical effect of laparoscopy-assisted radical resection of colorectal cancer and to analyze the changes of nutritional level and immune status before and after operation in patients with colorectal cancer.Method The clinical data of 92 patients with colorectal cancer were retrospectively analyzed.According to the different surgical methods,the patients were divided into study group and control group,with 46 cases in each.Laparoscopy-radical resection of colorectal cancer was performed in the study group,while routine open surgery was administered in the control group.The perioperative indexes(operative time,intraoperative blood loss,time to postoperative anal exhaust,postoperative hospitalization) were observed in the two groups.The immune indexes [natural killer(NK) cells,C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)] and nutritional indexes [albumin(ALB),hemoglobin(Hb),transferrin(TRF),prealbumin(PRE),retinol binding protein(RBP)] of the two groups were measured by immunoturbidimetry.Result The volume of intraoperative blood loss in the study group was significantly lower than that in the control group,the time to postoperative anal exhaust and length of hospital stay were significantly shorter than those in the control group,while the operative time was significantly longer than that in the control group(P<0.01).After 7 days of operation,the level of ALB,Hb,TRF,PRE and RBP in the control group were lower than those in the study group(P<0.05).During the same period,the CRP,IL-6 and TNF-α level in study group were significantly decreased compared with control group,while NK cells were higher than that in control group,showing statistically significant difference(P<0.01).Conclusion Laparoscopic surgery is feasible in clinical practice for colorectal cancer patients.Laparoscopic surgery has little effect on the immunity of patients,and it can promote the recovery and improve the nutritional level of patients after operation.
Objective To observe the clinical effect of laparoscopy-assisted radical resection of colorectal cancer and to analyze the changes of nutritional level and immune status before and after operation in patients with colorectal cancer.Method The clinical data of 92 patients with colorectal cancer were retrospectively analyzed.According to the different surgical methods,the patients were divided into study group and control group,with 46 cases in each.Laparoscopy-radical resection of colorectal cancer was performed in the study group,while routine open surgery was administered in the control group.The perioperative indexes(operative time,intraoperative blood loss,time to postoperative anal exhaust,postoperative hospitalization) were observed in the two groups.The immune indexes [natural killer(NK) cells,C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)] and nutritional indexes [albumin(ALB),hemoglobin(Hb),transferrin(TRF),prealbumin(PRE),retinol binding protein(RBP)] of the two groups were measured by immunoturbidimetry.Result The volume of intraoperative blood loss in the study group was significantly lower than that in the control group,the time to postoperative anal exhaust and length of hospital stay were significantly shorter than those in the control group,while the operative time was significantly longer than that in the control group(P<0.01).After 7 days of operation,the level of ALB,Hb,TRF,PRE and RBP in the control group were lower than those in the study group(P<0.05).During the same period,the CRP,IL-6 and TNF-α level in study group were significantly decreased compared with control group,while NK cells were higher than that in control group,showing statistically significant difference(P<0.01).Conclusion Laparoscopic surgery is feasible in clinical practice for colorectal cancer patients.Laparoscopic surgery has little effect on the immunity of patients,and it can promote the recovery and improve the nutritional level of patients after operation.
引文
[1]鲁斌,黄海燕,王海明,等.腹腔镜辅助结肠癌根治术对患者外周血自然杀伤细胞数量的影响[J/OL].中华危重症医学杂志(电子版),2016,9(2):125-126.[2018-05-10].http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhwzzyxzz201602012.
[2]卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2015版)[J].中华消化外科杂志,2015,14(10):783-799.
[3]叶平江,郭贵龙,应晓江,等.腹腔镜与开腹结直肠癌根治术对机体免疫系统影响的比较研究[J].中国内镜杂志,2011,17(5):478-480;484.
[4]So JS,Cheong C,Oh SY,et al.Corrigendum:correction of the IRB approval number.accuracy of preoperative local staging of primary colorectal cancer by using computed tomography:reappraisal based on data collected at a highly organized cancer center[J].Ann Coloproctol,2017,33(6):255.
[5]王隽婕,韩承新.腹腔镜结直肠切除术对机体免疫生理影响的研究进展[J].腹腔镜外科杂志,2014,19(3):229-233.
[6]连爽.腹腔镜或开放结直肠癌根治手术对患者围手术期营养状态的影响[D].大连:大连医科大学,2013.
[7]律玉臣,张建立,孙振清.高龄患者腹腔镜结直肠癌根治术围手术期对机体应激及内脏蛋白的影响[J].现代生物医学进展,2010,10(7):1351-1355.
[8]李天舒,蒋海弦,张飞功,等.腹腔镜与传统结直肠癌根治术的临床对比研究[J].实用临床医药杂志,2015,19(7):149-150.
[9]Galizia G,Lieto E,Auricchio A,et al.Naples prognostic score,based on nutritional and inflammatory status,is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer[J].Dis Colon Rectum,2017,60(12):1273-1284.
[10]潘书鸿,张从雨,潘绪科,等.腹腔镜与开腹结直肠癌手术对机体应激反应及细胞免疫功能影响的比较[J].中国现代普通外科进展,2014,17(5):408-411.
[11]白飞,聂少麟,付忠平,等.腹腔镜和开腹结直肠癌根治术对Ⅱ、Ⅲ期结直肠癌患者机体免疫功能的影响[J].世界临床医学,2017,11(19):73.
[12]邹瞭南,林展宏,朱首伦,等.腹腔镜下结直肠癌根治术围手术期肠外营养的临床研究[J].广东医学,2011,32(17):2320-2322.
[13]Jayne D,Pigazzi A,Marshall H,et al.Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer:the ROLARR randomized clinical trial[J].JAMA,2017,318(16):1569-1580.
[14]朱达坚,陈小伍,伍锦浩,等.结直肠癌围手术期替代应用肠道微生态制剂对肠道菌群及机体免疫功能的影响[J].南方医科大学学报,2012,32(8):1190-1193.
[15]黄文辉,林龙,侯开庆.老年结直肠癌患者开放性与腹腔镜手术近期疗效及术后并发症对比[J].中国老年学杂志,2017,37(14):3515-3517.
[2]卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2015版)[J].中华消化外科杂志,2015,14(10):783-799.
[3]叶平江,郭贵龙,应晓江,等.腹腔镜与开腹结直肠癌根治术对机体免疫系统影响的比较研究[J].中国内镜杂志,2011,17(5):478-480;484.
[4]So JS,Cheong C,Oh SY,et al.Corrigendum:correction of the IRB approval number.accuracy of preoperative local staging of primary colorectal cancer by using computed tomography:reappraisal based on data collected at a highly organized cancer center[J].Ann Coloproctol,2017,33(6):255.
[5]王隽婕,韩承新.腹腔镜结直肠切除术对机体免疫生理影响的研究进展[J].腹腔镜外科杂志,2014,19(3):229-233.
[6]连爽.腹腔镜或开放结直肠癌根治手术对患者围手术期营养状态的影响[D].大连:大连医科大学,2013.
[7]律玉臣,张建立,孙振清.高龄患者腹腔镜结直肠癌根治术围手术期对机体应激及内脏蛋白的影响[J].现代生物医学进展,2010,10(7):1351-1355.
[8]李天舒,蒋海弦,张飞功,等.腹腔镜与传统结直肠癌根治术的临床对比研究[J].实用临床医药杂志,2015,19(7):149-150.
[9]Galizia G,Lieto E,Auricchio A,et al.Naples prognostic score,based on nutritional and inflammatory status,is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer[J].Dis Colon Rectum,2017,60(12):1273-1284.
[10]潘书鸿,张从雨,潘绪科,等.腹腔镜与开腹结直肠癌手术对机体应激反应及细胞免疫功能影响的比较[J].中国现代普通外科进展,2014,17(5):408-411.
[11]白飞,聂少麟,付忠平,等.腹腔镜和开腹结直肠癌根治术对Ⅱ、Ⅲ期结直肠癌患者机体免疫功能的影响[J].世界临床医学,2017,11(19):73.
[12]邹瞭南,林展宏,朱首伦,等.腹腔镜下结直肠癌根治术围手术期肠外营养的临床研究[J].广东医学,2011,32(17):2320-2322.
[13]Jayne D,Pigazzi A,Marshall H,et al.Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer:the ROLARR randomized clinical trial[J].JAMA,2017,318(16):1569-1580.
[14]朱达坚,陈小伍,伍锦浩,等.结直肠癌围手术期替代应用肠道微生态制剂对肠道菌群及机体免疫功能的影响[J].南方医科大学学报,2012,32(8):1190-1193.
[15]黄文辉,林龙,侯开庆.老年结直肠癌患者开放性与腹腔镜手术近期疗效及术后并发症对比[J].中国老年学杂志,2017,37(14):3515-3517.