多孔腹腔镜手术治疗卵巢癌的效果及对外周血T淋巴细胞的影响
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摘要
目的探讨腹腔镜手术治疗卵巢癌的效果及其对患者外周血T淋巴细胞的影响。方法选取80例接受手术治疗的卵巢癌患者,根据手术方法不同分为腔镜组(腹腔镜手术)43例和对照组(开腹手术)37例。对比两组患者的手术时间、术中出血量、淋巴结清扫数量、首次肛门排气时间、术后住院时间、手术前后外周血中T淋巴细胞亚群水平及手术并发症的发生情况,并采用视觉模拟评分法(VAS)评估患者术后不同时间的疼痛程度。结果腔镜组患者的手术时间明显长于对照组(P﹤0.01),术中出血量明显少于对照组(P﹤0.01),首次肛门排气时间、术后住院时间均明显短于对照组(P﹤0.01);但两组患者的淋巴结清扫数量比较,差异无统计学意义(P﹥0.05)。术前,腔镜组和对照组患者的CD3+、CD4+、CD8+、CD4+/CD8+水平比较,差异均无统计学意义(P﹥0.05);术后,腔镜组患者的CD3+、CD4+、CD4+/CD8+水平均高于对照组(P﹤0.05),CD8+水平低于对照组(P﹤0.05)。两组患者术后不同时间点的VAS评分比较,差异有统计学意义(P﹤0.01);腔镜组患者手术并发症的总发生率为6.98%,低于对照组的24.32%(P﹤0.05)。结论与开腹手术比较,卵巢癌患者腹腔镜术后恢复快,疼痛程度低,且对免疫功能的影响小。
Objective To investigate the effect of laparoscopic surgery on ovarian cancer and the influence on peripheral blood T lymphocytes. Method Eighty patients with ovarian cancer were enrolled as endoscopy group(laparoscopic surgery, n=43) and control group(laparotomy, n=37). The operative time, intraoperative blood loss, number of dissected lymph nodes, time to first flatus, postoperative hospital stay, and the level of peripheral blood T lymphocyte subsets before and after surgery, and surgical complications at different time points after operation were compared between the two groups. Visual analogue score(VAS) was used to evaluate the degree of postoperative pain at different time. Result The operative time of endoscopy group was significantly longer than that of control group(P<0.01), while the intraoperative blood loss was less, and the time of first flatus and postoperative hospital stay were shorter compared to that of control group(P<0.01); there was no significant difference regarding the number of lymph node dissection between the two groups(P>0.05). Before surgery, there was no significant difference in CD3+, CD4+, CD8+, and CD4+/CD8+between endoscopy group and control group(P>0.05); while after treatment, the CD3+, CD4+, and CD4+/CD8+in endoscopy group were higher than those in control group(P<0.05), but CD8+was lower instead(P<0.05). After surgery, VAS scores at different postoperative time points were compared between the two groups, and the differences were statistically significant(P<0.01), and the overall incidence rate of complications in endoscopy group was 6.98%, which was lower than that of control group at 24.32%(P<0.05). Conclusion The effect of laparoscopic surgery for ovarian cancer is similar to that of laparotomy, with less time needed for recover after surgery, and lower degree of pain, besides, the immune function of patients is hardly affected.
Objective To investigate the effect of laparoscopic surgery on ovarian cancer and the influence on peripheral blood T lymphocytes. Method Eighty patients with ovarian cancer were enrolled as endoscopy group(laparoscopic surgery, n=43) and control group(laparotomy, n=37). The operative time, intraoperative blood loss, number of dissected lymph nodes, time to first flatus, postoperative hospital stay, and the level of peripheral blood T lymphocyte subsets before and after surgery, and surgical complications at different time points after operation were compared between the two groups. Visual analogue score(VAS) was used to evaluate the degree of postoperative pain at different time. Result The operative time of endoscopy group was significantly longer than that of control group(P<0.01), while the intraoperative blood loss was less, and the time of first flatus and postoperative hospital stay were shorter compared to that of control group(P<0.01); there was no significant difference regarding the number of lymph node dissection between the two groups(P>0.05). Before surgery, there was no significant difference in CD3+, CD4+, CD8+, and CD4+/CD8+between endoscopy group and control group(P>0.05); while after treatment, the CD3+, CD4+, and CD4+/CD8+in endoscopy group were higher than those in control group(P<0.05), but CD8+was lower instead(P<0.05). After surgery, VAS scores at different postoperative time points were compared between the two groups, and the differences were statistically significant(P<0.01), and the overall incidence rate of complications in endoscopy group was 6.98%, which was lower than that of control group at 24.32%(P<0.05). Conclusion The effect of laparoscopic surgery for ovarian cancer is similar to that of laparotomy, with less time needed for recover after surgery, and lower degree of pain, besides, the immune function of patients is hardly affected.
引文
[1]张爽爽,夏庆民,郑荣寿,等.中国2010年卵巢癌发病与死亡分析[J].中国肿瘤, 2016, 25(3):169-173.
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[8] Lago V, Minig L, Fotopoulou C. Incidence of lymph node metastasesin apparent early stage low grade epithelial ovarian cancer:a comprehensive review[J]. Int J Gynecol Cancer, 2016, 26(8):1407-1414.
[9]翟振波,张彬玉,张秀珍,等.腹腔镜和开腹手术治疗早期卵巢癌的临床分析[J].现代肿瘤医学, 2017, 25(11):1770-1773.
[10] Ataseven B, Grimm C, Harter P, et al. Prognostic impact of port-site metastasis after diagnostic laparoscopy for epithelial ovarian cancer[J]. Ann Surg Oncol, 2016, 23(Suppl5):834-840.
[11]余炜昶,王燕,郎雁,等.腹腔镜下早期卵巢癌全面分期手术的随访观察[J].中国内镜杂志, 2016, 22(10):37-42.
[12]江彩霞,程忠平,万悦竹,等.腹腔镜与开腹手术在早期卵巢癌全面分期手术中的疗效和并发症比较[J].国际妇产科学杂志, 2016, 43(5):528-538.
[13] Ghezzi F, Cromi A, Fanfani F, et al. Laparoscopic fertilitysparing surgery for early ovarian epithelial cancer:a multiinstitutional experience[J]. Gynecol Oncol, 2016, 141(3):461-465.
[14] Schr?der L, Rudlowski C, Kutkuhn P, et al. Impact of open laparoscopy in patients under suspicion of ovarian cancer[J]. Anticancer Res, 2016, 36(7):3459-3464.
[15] Nakonechny QB, Gilks CB. Ovarian cancer in hereditary cancer susceptibility syndromes[J]. Surg Pathol Clin,2016, 9(2):189-199.
[16]热孜婉古丽·吾布力,刘晓婉,韩莉莉,等.腹腔镜和开腹手术治疗早期卵巢癌的临床分析及其对机体免疫功能的影响[J].结直肠肛门外科, 2017, 23(S1):36-38.
[2]董经纬,车向明.硬膜外镇痛与静脉镇痛对卵巢肿瘤减灭术患者应激、T淋巴细胞亚群及肿瘤因子的影响[J].临床与病理杂志, 2019, 39(2):281-286.
[3]王雪梅,马欢,刘婉,等.腹腔镜与开腹手术对早期卵巢癌临床疗效评价的随机对照分析[J].中国妇幼健康研究,2016, 27(8):991-993.
[4]仝玉珠.腹腔镜下全面分期手术治疗早期卵巢癌疗效观察[J].新乡医学院学报, 2018, 35(9):804-806.
[5]曹泽毅.妇科常见肿瘤诊治指南[M].北京:人民卫生出版社, 2007:70-71.
[6]朱熠,张国楠.卵巢癌、输卵管癌和腹膜癌FIGO2013分期和临床意义的解读[J].肿瘤预防与治疗, 2015, 28(5):291-294.
[7]李洋.腹腔镜手术治疗早期卵巢癌疗效观察[J].新乡医学院学报, 2019, 36(2):159-161.
[8] Lago V, Minig L, Fotopoulou C. Incidence of lymph node metastasesin apparent early stage low grade epithelial ovarian cancer:a comprehensive review[J]. Int J Gynecol Cancer, 2016, 26(8):1407-1414.
[9]翟振波,张彬玉,张秀珍,等.腹腔镜和开腹手术治疗早期卵巢癌的临床分析[J].现代肿瘤医学, 2017, 25(11):1770-1773.
[10] Ataseven B, Grimm C, Harter P, et al. Prognostic impact of port-site metastasis after diagnostic laparoscopy for epithelial ovarian cancer[J]. Ann Surg Oncol, 2016, 23(Suppl5):834-840.
[11]余炜昶,王燕,郎雁,等.腹腔镜下早期卵巢癌全面分期手术的随访观察[J].中国内镜杂志, 2016, 22(10):37-42.
[12]江彩霞,程忠平,万悦竹,等.腹腔镜与开腹手术在早期卵巢癌全面分期手术中的疗效和并发症比较[J].国际妇产科学杂志, 2016, 43(5):528-538.
[13] Ghezzi F, Cromi A, Fanfani F, et al. Laparoscopic fertilitysparing surgery for early ovarian epithelial cancer:a multiinstitutional experience[J]. Gynecol Oncol, 2016, 141(3):461-465.
[14] Schr?der L, Rudlowski C, Kutkuhn P, et al. Impact of open laparoscopy in patients under suspicion of ovarian cancer[J]. Anticancer Res, 2016, 36(7):3459-3464.
[15] Nakonechny QB, Gilks CB. Ovarian cancer in hereditary cancer susceptibility syndromes[J]. Surg Pathol Clin,2016, 9(2):189-199.
[16]热孜婉古丽·吾布力,刘晓婉,韩莉莉,等.腹腔镜和开腹手术治疗早期卵巢癌的临床分析及其对机体免疫功能的影响[J].结直肠肛门外科, 2017, 23(S1):36-38.