腹腔镜结直肠全系膜切除术对结直肠癌患者外周血炎症因子和免疫功能的影响
|
摘要
目的:探讨腹腔镜结直肠全系膜切除术对结直肠癌患者外周血炎症因子和免疫功能的影响。方法:400例结直肠癌患者均分为对照组和研究组,对照组采用传统开腹结直肠全系膜切除术治疗,研究组采用腹腔镜结直肠全系膜切除术治疗,比较两组患者手术时间、术中出血量、术后首次排气时间及首次进食时间、术后住院时间;于术前、术后第1及第7天时采集患者外周血,检测血清肿瘤坏死因子(TNF-ɑ)、C反应蛋白(CRP)、降钙素原(PCT)及白细胞介素-6(IL-6)、免疫球蛋白G (IgG)、IgM及IgA水平,检测外周血CD3+、CD4+、CD8+淋巴细胞亚群百分比及CD4+/CD8+比值;随访5年,比较两组患者并发症及复发、死亡等预后情况。结果:与对照组比较,研究组术后首次排气时间及首次进食时间、术后住院时间均显著缩短,术中出血量显著降低(P<0.05);术后第1及第7天时,两组患者TNF-ɑ、CRP、PCT及IL-6水平较术前显著升高,IgG、IgM、IgA水平较术前显著降低(P<0.05);术后第1及第7天时,研究组TNF-ɑ、CRP、PCT及IL-6水平显著低于同时点对照组,IgG、IgM、IgA水平显著高与同时点对照组(P<0.05);术后第1天,两组患者外周血CD3+、CD4+淋巴细胞百分比及CD4+/CD8+比值较术前显著降低,CD8+淋巴细胞百分比较术前显著升高(P<0.05);术后第7天,研究组CD3+、CD4+、CD8+淋巴细胞百分比及CD4+/CD8+比值恢复至术前水平(P>0.05),对照组与术前比较差异无统计学意义(P<0.05);研究组患者术后感染、术后出血、排尿功能障碍及排便功能障碍等并发症显著低于对照组(P<0.05);2组患者术后随访5年病死率及复发率比较差异无统计学意义(P>0.05)。结论:结直肠癌患者采用腹腔镜结直肠全系膜切除术治疗,具有出血量少、术后并发症少、恢复快等优势,手术对患者炎症因子和免疫功能的影响较小。
Objective:To investigate the effect of laparoscopic total mesorectal excision on inflammatory factors and immune function in peripheral blood of patients with colorectal cancer.Methods:400 patients with colorectal cancer were divided into control group and study group.The control group was treated with traditional open total mesorectal excision.The study group was treated with laparoscopic total mesorectal excision.Surgery time,intraoperative blood loss,first exhaust time,first feeding time and postoperative hospital stay were compared between the two groups.Peripheral blood was collected before operation and on the 1 st and 7 th day after operation to detect tumor necrosis factor(TNF-ɑ),Creactive protein(CRP),procalcitonin(PCT) and interleukin-6(IL-6),immunoglobulin G(IgG),IgM,IgA levels,and the percentage of CD3+,CD4+,CD8+lymphocyte subsets and the ratio of CD4+/CD8+in peripheral blood were measured.Complications and prognosis such as recurrence and death were compared between the two groups.Results:Compared with the control group,first exhaust time,first feeding time and postoperative hospital stay were significantly shorter and the surgical bleeding volume were significantly lower in the study group(P<0.05).The levels of TNF-ɑ,CRP,PCT and IL-6 on the 1 st and 7 th day after operation were significantly higher than those before operation,and IgG,IgM,and IgA levels were significantly lower than those before operation(P<0.05).The levels of TNF-ɑ,CRP,PCT and IL-6 in study group after operation were lower than those in control group,and IgG,IgM,and IgA levels were higher than those in control group(P<0.05).On the first day after operation,the percentage of CD3+,CD4+lymphocyte and CD4+/CD8+ratio in peripheral blood of the two groups were significantly lower than those before operation,and the percentage of CD8+lymphocyte was significantly higher than that before operation(P<0.05).On the 7 th day after operation,the percentage of CD3+,CD4+,CD8+lymphocyte and the ratio of CD4+/CD8+in the study group recovered to the preoperative level(P>0.05).The complications of infection,bleeding,dysfunction of urination and defecation in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in mortality and recurrence rate between the two groups after 5-year follow-up(P>0.05).Conclusions:Laparoscopic total mesorectal excision for colorectal cancer patients has the advantages of less bleeding,less postoperative complications,faster recovery,less release of inflammatory factors and less influence on immune function.
Objective:To investigate the effect of laparoscopic total mesorectal excision on inflammatory factors and immune function in peripheral blood of patients with colorectal cancer.Methods:400 patients with colorectal cancer were divided into control group and study group.The control group was treated with traditional open total mesorectal excision.The study group was treated with laparoscopic total mesorectal excision.Surgery time,intraoperative blood loss,first exhaust time,first feeding time and postoperative hospital stay were compared between the two groups.Peripheral blood was collected before operation and on the 1 st and 7 th day after operation to detect tumor necrosis factor(TNF-ɑ),Creactive protein(CRP),procalcitonin(PCT) and interleukin-6(IL-6),immunoglobulin G(IgG),IgM,IgA levels,and the percentage of CD3+,CD4+,CD8+lymphocyte subsets and the ratio of CD4+/CD8+in peripheral blood were measured.Complications and prognosis such as recurrence and death were compared between the two groups.Results:Compared with the control group,first exhaust time,first feeding time and postoperative hospital stay were significantly shorter and the surgical bleeding volume were significantly lower in the study group(P<0.05).The levels of TNF-ɑ,CRP,PCT and IL-6 on the 1 st and 7 th day after operation were significantly higher than those before operation,and IgG,IgM,and IgA levels were significantly lower than those before operation(P<0.05).The levels of TNF-ɑ,CRP,PCT and IL-6 in study group after operation were lower than those in control group,and IgG,IgM,and IgA levels were higher than those in control group(P<0.05).On the first day after operation,the percentage of CD3+,CD4+lymphocyte and CD4+/CD8+ratio in peripheral blood of the two groups were significantly lower than those before operation,and the percentage of CD8+lymphocyte was significantly higher than that before operation(P<0.05).On the 7 th day after operation,the percentage of CD3+,CD4+,CD8+lymphocyte and the ratio of CD4+/CD8+in the study group recovered to the preoperative level(P>0.05).The complications of infection,bleeding,dysfunction of urination and defecation in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in mortality and recurrence rate between the two groups after 5-year follow-up(P>0.05).Conclusions:Laparoscopic total mesorectal excision for colorectal cancer patients has the advantages of less bleeding,less postoperative complications,faster recovery,less release of inflammatory factors and less influence on immune function.
引文
[1] BRENNER H,KLOOR M,POX C P. Colorectal cancer[J]. Lancet,2014,383(9927):1490-1502.
[2]甘涛,李威,夏涛,等.腹腔镜手术与开腹结直肠癌根治术对免疫系统影响的比较[J].广东医学,2012,33(20):3125-3127.
[3]于晓强,何和平,沈泽旭.腹腔镜手术与传统开腹手术在结直肠癌根治术中的临床疗效比较[J].西部医学,2015,27(6):911-913.
[4]谷化平,尚培中. EGFR、VEGF和PTEN在结直肠癌中表达及与其临床病理特征的关系[J].实用癌症杂志,2011,26(3):259-262.
[5]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.
[6] REISSFELDER C,STAMOVAS,GOSSMANN C,et al.Tumor-specific cytotoxic T lymphocyte activity determines colorectal cancer patient prognosis[J]. J Clin Invest,2015,125(2):739-751.
[7]RASMUSSEN L J H,SCHULTZ M,GAARDSTING A,et al. Inflammatory biomarkers and cancer:CRP and su PAR as markers of incident cancer in patients with serious nonspecific symptoms and signs of cancer[J]. International Journal of Cancer,2017,141(1):191-199.
[8]许超,池畔.腹腔镜与开腹结直肠癌根治术后肠梗阻发生率比较的Meta分析[J].中华胃肠外科杂志,2012,15(10):1044-1047.
[9]WANG C L,QU G,XU H W. The short-and long-term outcomes of laparoscopic versus open surgery for colorectal cancer:a meta-analysis[J]. International Journal of Colorectal Disease,2014,29(3):309.
[10]龙结根,蒋志宏,龙凤,等.快速康复外科在腹腔镜结直肠癌围手术期中的应用[J].西部医学,2015,27(1):102-104.
[11]杨勇,张红雁.术前同期放化疗在直肠癌综合治疗中的地位[J/CD].中华临床医师杂志(电子版),2013,7(24):11662-11665.
[12]HAN S A,LEE W Y,PARK C M,et al. Comparison of immunologic outcomes of laparoscopic VS open approaches in clinical stageⅢcolorectal cancer[J]. Int J Colorectal Dis,2010,25(5):631-638.
[13]魏鸿,王灿.腹腔镜下结直肠全系膜切除术与传统开腹手术对结直肠癌患者的免疫功能及预后比较[J].医学综述,2016,22(17):3462-3464.
[14]LUJAN J,VALERO G,BIONDO S,et al. Laparoscopic versus open surgery for rectal cancer:results of a prospective multicentre analysis of 4,970 patients[J]. Surg Endosc,2013,27(1):295-302.
[15]鲁德斌,刘西平,胡林忠.腹腔镜与开腹手术治疗直肠癌疗效及对患者应激反应、免疫功能和生活质量的影响[J].海南医学院学报,2016,22(3):289-291.
[16]何炜,王全玉,李晓敏,等. Notchl和C-Met在结直肠癌中的表达及其与血管生成拟态和预后的关系[J].西部医学,2016,28(9):1203-1205.
[17]WILLIAMS M R,MCMEEKIN S,WILSON R J,et al.Predictive value of C-Reactive protein for complications post-laparoscopic roux-en-y gastric bypass[J]. Obesity surgery,2017,27(3):709-715.
[18]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.
[19]牛文博,周超熙,张娟,等.结直肠癌腹腔镜与开腹手术对免疫功能的影响分析[J].中国免疫学杂志,2015,31(11):670-672.
[20]宋虎,宋军,梁勇,等.腹腔镜与开腹结直肠癌根治术对机体免疫功能影响的Meta分析[J].中华胃肠外科杂志,2014,1(8):799-804.
[21]黄建国,孙钦立,周忠晋,等.腹腔镜CME与开腹CME对患者血清学指标及外周血免疫分子含量的影响[J].海南医学院学报,2015,21(7):984-987.
[22]HEEREN A M,KENTER G G,JORDANOVA E S,et al. CD14(+)macrophage-like cells as the linchpin of cervical cancer perpetrated immune suppression and early metastatic spread:a new therapeutic lead[J]. Oncoimmun Ology,2015,4(6):1-10.
[23]姜艳辉,曲红梅,孙伟,等.腹腔镜和开腹结直肠癌根治术对患者机体炎症免疫反应的影响[J].实用癌症杂志,2015,31(4):491-493.
[24]MORELLI L,CECCARELLI C,FRANCO G D,et al.Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer[J]. International Journal of Colorectal Disease,2016,31(4):913-915.
[25]何利,何茂梁,袁波,等.腹腔镜手术治疗对结直肠癌患者血清炎性因子、VEGF、MMP-9、氧化应激及免疫功能的影响[J].海南医学院学报,2017,23(18):2546-2549.
[26]RAMIREZ M F,AI D,BAUER M,et al. Innate immune function after breast,lung,and colorectal cancer surgery[J]. The Journal of Surgicalresearch,2015,194(1):185-193.
[27]赖添武,赵权,徐奎,等.结直肠癌传统开腹手术与腹腔镜手术对免疫功能影响的对比研究[J].微创医学,2014,9(3):293-295.
[28]HE X,LI G,ZHANG R,ET A L. Effect of arterial infusion with methylene blue during total mesorectal excision on urination function and sexual function in male patients with rectal cancer][J]. Chinese Journal of Gastrointestinal Surgery,2016,19(4):414.
[2]甘涛,李威,夏涛,等.腹腔镜手术与开腹结直肠癌根治术对免疫系统影响的比较[J].广东医学,2012,33(20):3125-3127.
[3]于晓强,何和平,沈泽旭.腹腔镜手术与传统开腹手术在结直肠癌根治术中的临床疗效比较[J].西部医学,2015,27(6):911-913.
[4]谷化平,尚培中. EGFR、VEGF和PTEN在结直肠癌中表达及与其临床病理特征的关系[J].实用癌症杂志,2011,26(3):259-262.
[5]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.
[6] REISSFELDER C,STAMOVAS,GOSSMANN C,et al.Tumor-specific cytotoxic T lymphocyte activity determines colorectal cancer patient prognosis[J]. J Clin Invest,2015,125(2):739-751.
[7]RASMUSSEN L J H,SCHULTZ M,GAARDSTING A,et al. Inflammatory biomarkers and cancer:CRP and su PAR as markers of incident cancer in patients with serious nonspecific symptoms and signs of cancer[J]. International Journal of Cancer,2017,141(1):191-199.
[8]许超,池畔.腹腔镜与开腹结直肠癌根治术后肠梗阻发生率比较的Meta分析[J].中华胃肠外科杂志,2012,15(10):1044-1047.
[9]WANG C L,QU G,XU H W. The short-and long-term outcomes of laparoscopic versus open surgery for colorectal cancer:a meta-analysis[J]. International Journal of Colorectal Disease,2014,29(3):309.
[10]龙结根,蒋志宏,龙凤,等.快速康复外科在腹腔镜结直肠癌围手术期中的应用[J].西部医学,2015,27(1):102-104.
[11]杨勇,张红雁.术前同期放化疗在直肠癌综合治疗中的地位[J/CD].中华临床医师杂志(电子版),2013,7(24):11662-11665.
[12]HAN S A,LEE W Y,PARK C M,et al. Comparison of immunologic outcomes of laparoscopic VS open approaches in clinical stageⅢcolorectal cancer[J]. Int J Colorectal Dis,2010,25(5):631-638.
[13]魏鸿,王灿.腹腔镜下结直肠全系膜切除术与传统开腹手术对结直肠癌患者的免疫功能及预后比较[J].医学综述,2016,22(17):3462-3464.
[14]LUJAN J,VALERO G,BIONDO S,et al. Laparoscopic versus open surgery for rectal cancer:results of a prospective multicentre analysis of 4,970 patients[J]. Surg Endosc,2013,27(1):295-302.
[15]鲁德斌,刘西平,胡林忠.腹腔镜与开腹手术治疗直肠癌疗效及对患者应激反应、免疫功能和生活质量的影响[J].海南医学院学报,2016,22(3):289-291.
[16]何炜,王全玉,李晓敏,等. Notchl和C-Met在结直肠癌中的表达及其与血管生成拟态和预后的关系[J].西部医学,2016,28(9):1203-1205.
[17]WILLIAMS M R,MCMEEKIN S,WILSON R J,et al.Predictive value of C-Reactive protein for complications post-laparoscopic roux-en-y gastric bypass[J]. Obesity surgery,2017,27(3):709-715.
[18]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.
[19]牛文博,周超熙,张娟,等.结直肠癌腹腔镜与开腹手术对免疫功能的影响分析[J].中国免疫学杂志,2015,31(11):670-672.
[20]宋虎,宋军,梁勇,等.腹腔镜与开腹结直肠癌根治术对机体免疫功能影响的Meta分析[J].中华胃肠外科杂志,2014,1(8):799-804.
[21]黄建国,孙钦立,周忠晋,等.腹腔镜CME与开腹CME对患者血清学指标及外周血免疫分子含量的影响[J].海南医学院学报,2015,21(7):984-987.
[22]HEEREN A M,KENTER G G,JORDANOVA E S,et al. CD14(+)macrophage-like cells as the linchpin of cervical cancer perpetrated immune suppression and early metastatic spread:a new therapeutic lead[J]. Oncoimmun Ology,2015,4(6):1-10.
[23]姜艳辉,曲红梅,孙伟,等.腹腔镜和开腹结直肠癌根治术对患者机体炎症免疫反应的影响[J].实用癌症杂志,2015,31(4):491-493.
[24]MORELLI L,CECCARELLI C,FRANCO G D,et al.Sexual and urinary functions after robot-assisted versus pure laparoscopic total mesorectal excision for rectal cancer[J]. International Journal of Colorectal Disease,2016,31(4):913-915.
[25]何利,何茂梁,袁波,等.腹腔镜手术治疗对结直肠癌患者血清炎性因子、VEGF、MMP-9、氧化应激及免疫功能的影响[J].海南医学院学报,2017,23(18):2546-2549.
[26]RAMIREZ M F,AI D,BAUER M,et al. Innate immune function after breast,lung,and colorectal cancer surgery[J]. The Journal of Surgicalresearch,2015,194(1):185-193.
[27]赖添武,赵权,徐奎,等.结直肠癌传统开腹手术与腹腔镜手术对免疫功能影响的对比研究[J].微创医学,2014,9(3):293-295.
[28]HE X,LI G,ZHANG R,ET A L. Effect of arterial infusion with methylene blue during total mesorectal excision on urination function and sexual function in male patients with rectal cancer][J]. Chinese Journal of Gastrointestinal Surgery,2016,19(4):414.