腹腔镜结直肠癌根治术与开腹结直肠癌根治术对结直肠癌患者术后炎症反应及免疫功能的影响比较
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摘要
目的比较腹腔镜结直肠癌根治术与开腹结直肠癌根治术对结直肠癌患者术后炎症反应和免疫功能的影响。方法选择2016年1月至2018年3月驻马店市中心医院收治的80例结直肠癌患者为研究对象,按照手术方式分为观察组和对照组,每组40例。观察组患者采取腹腔镜结直肠癌根治术,对照组患者采取传统开腹结直肠癌根治术。记录2组患者的手术时间、术中出血量、切口长度、术后肛门排气时间、淋巴结清扫数目及住院时间;分别于手术前和手术后第2天采用酶联免疫吸附法检测患者血清C反应蛋白(CRP)、白细胞介素-6(IL-6)及肿瘤坏死因子(TNF-α)水平,应用流式细胞仪检测外周血CD4~+、CD8~+、自然杀伤(NK)细胞水平,并计算CD4~+与CD8~+的比值(CD4~+/CD8~+)。结果观察组患者术中出血量少于对照组,切口长度、术后肛门排气时间和住院时间短于对照组(P<0.05); 2组患者手术时间、淋巴结清扫数目比较差异无统计学意义(P>0.05)。2组患者术前血清CPR、IL-6及TNF-α水平比较差异均无统计学意义(P>0.05); 2组患者术后血清CPR、IL-6及TNF-α水平显著高于术前(P<0.05),术后观察组患者血清CPR、IL-6及TNF-α水平显著低于对照组(P<0.05)。2组患者术前外周血CD4~+、CD8~+、CD4~+/CD8~+及NK细胞水平比较差异均无统计学意义(P>0.05)。2组患者术后外周血CD4~+、CD4~+/CD8~+、NK细胞水平显著低于术前,CD8~+水平显著高于术前(P<0.05);术后观察组患者外周血CD4~+、CD4~+/CD8~+、NK细胞水平显著高于对照组,CD8~+水平显著低于对照组(P<0.05)。结论与开腹结肠癌根治术相比,腹腔镜结肠癌根治术具有创伤小、出血量少、机体炎症反应轻、患者术后恢复快等优点,且对患者免疫功能影响小。
Objective To compare the effect between laparoscopic radical resection and open radical resection of colorectal cancer on postoperative inflammatory response and immune function. Methods Eighty patients with colorectal cancer admitted to Zhumadian Central Hospital from January 2016 to March 2018 were selected as the study subjects. The patients were divided into observation group and control group according to the operation method,with 40 cases in each group.The patients in the observation group were performed with laparoscopic radical resection of colorectal cancer,while the patients in the control group were performed with traditional open resection of colorectal cancer. The operation time,intraoperative bleeding volume,incision length,postoperative anal exhaust time,the number of lymph node dissection and hospitalization time were recorded. The levels of serum C-reactive protein(CRP),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were detected by enzyme linked immunosorbent assay before and the second day after operation. The levels of CD4~+,CD8~+,natural killer(NK) cells in peripheral blood were measured by flow cytometry,and the ratio of CD4~+ to CD8~+(CD4~+/CD8~+) was calculated. Results Compared with the control group,the intraoperative bleeding volume was more,and the incision length,postoperative anal exhaust time and hospitalization time was shorter in the observation group(P<0.05). There was no significant difference in operation time and the number of lymph node dissection between the two groups(P>0.05). There was no significant difference in the levels of serum CPR,IL-6 and TNF-α between the two groups before operation(P>0.05). The levels of serum CPR,IL-6 and TNF-α after operation were significantly higher than those before operation in the two groups(P<0.05). The levels of serum CPR,IL-6 and TNF-α in the observation group were significantly lower than those in the control group after operation(P<0.05). There was no significant difference in the levels of CD4~+,CD8~+,CD4~+/CD8~+ and NK cells between the two groups before operation(P>0.05). Compared with before operation,the levels of CD4~+,CD4~+/CD8~+ and NK cells in peripheral blood were significantly lower,and the level of CD8~+ was significantly higher after operation in the two groups(P<0.05). The levels of CD4~+,CD4~+/CD8~+ and NK cells in peripheral blood of patients in the observation group were significantly higher than those in the control group,and the level of CD8~+ was significantly lower than that in the control group after operation(P<0.05). Conclusion Compared with open radical resection of colon cancer,the laparoscopic radical resection of colon cancer has the advantages of less trauma,less bleeding,less inflammation reaction,faster postoperative recovery and less impact on patients' immune function.
Objective To compare the effect between laparoscopic radical resection and open radical resection of colorectal cancer on postoperative inflammatory response and immune function. Methods Eighty patients with colorectal cancer admitted to Zhumadian Central Hospital from January 2016 to March 2018 were selected as the study subjects. The patients were divided into observation group and control group according to the operation method,with 40 cases in each group.The patients in the observation group were performed with laparoscopic radical resection of colorectal cancer,while the patients in the control group were performed with traditional open resection of colorectal cancer. The operation time,intraoperative bleeding volume,incision length,postoperative anal exhaust time,the number of lymph node dissection and hospitalization time were recorded. The levels of serum C-reactive protein(CRP),interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were detected by enzyme linked immunosorbent assay before and the second day after operation. The levels of CD4~+,CD8~+,natural killer(NK) cells in peripheral blood were measured by flow cytometry,and the ratio of CD4~+ to CD8~+(CD4~+/CD8~+) was calculated. Results Compared with the control group,the intraoperative bleeding volume was more,and the incision length,postoperative anal exhaust time and hospitalization time was shorter in the observation group(P<0.05). There was no significant difference in operation time and the number of lymph node dissection between the two groups(P>0.05). There was no significant difference in the levels of serum CPR,IL-6 and TNF-α between the two groups before operation(P>0.05). The levels of serum CPR,IL-6 and TNF-α after operation were significantly higher than those before operation in the two groups(P<0.05). The levels of serum CPR,IL-6 and TNF-α in the observation group were significantly lower than those in the control group after operation(P<0.05). There was no significant difference in the levels of CD4~+,CD8~+,CD4~+/CD8~+ and NK cells between the two groups before operation(P>0.05). Compared with before operation,the levels of CD4~+,CD4~+/CD8~+ and NK cells in peripheral blood were significantly lower,and the level of CD8~+ was significantly higher after operation in the two groups(P<0.05). The levels of CD4~+,CD4~+/CD8~+ and NK cells in peripheral blood of patients in the observation group were significantly higher than those in the control group,and the level of CD8~+ was significantly lower than that in the control group after operation(P<0.05). Conclusion Compared with open radical resection of colon cancer,the laparoscopic radical resection of colon cancer has the advantages of less trauma,less bleeding,less inflammation reaction,faster postoperative recovery and less impact on patients' immune function.
引文
[1]徐玉彬,张培建,王超臣.结直肠癌的病因及发病机制的研究进展[J/CD].中华临床医师杂志:电子版,2015,9(15):2912-2915.DOI:10.3877/cma.j.issn.1674-0785.2015.15.029.
[2]陈晓燕,罗金键.CXCL8在结直肠癌组织中的表达及其临床意义[J].新乡医学院学报,2018,35(6):505-508.
[3]套格苏,姜洪伟.结直肠癌常用治疗方法的研究进展[J].世界最新医学信息文摘,2018,18(55):82-84.
[4]吴亮,叶峰.腹腔镜微创术治疗结直肠癌患者的临床疗效[J].中国老年学杂志,2015,35(9):2442-2444.
[5]中华人民共和国国家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.结直肠癌诊疗规范:2015年版[J].中国实用外科杂志,2015,35(11):1177-1191.
[6]陈坤,黄秋驰.结直肠癌人群筛查研究进展[J].中国癌症防治杂志,2017,9(2):94-99.
[7]路丽娟,刘明浩,胡文炜,等.血清氨基酸和CEA/CA19-9联合测定对结直肠癌诊断的价[J].解放军医学杂志,2018,43(8):685-689.
[8]曾国祥,邬善敏.腹腔镜结直肠癌手术研究进展[J].医学综述,2017,23(3):557-560.
[9]杨钰,姜春玉.腹腔镜手术与开腹手术在结直肠癌根治术中临床疗效的对比研究[J].中国全科医学,2013,16(22):1990-1993.
[10]何毅,张鸿,何东生.腹腔镜根治术与传统开腹手术治疗结肠癌的临床效果对比分析[J].科技通报,2017,33(3):81-84.
[11]刘峰,何宋兵,郭兴坡,等.腹腔镜手术与传统开腹手术对老年结肠癌患者术后生理应激及凝血、认知功能和炎症因子的影响[J].中国老年学杂志,2018,38(2):342-344.
[12]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(5):670-673.
[13]PRABHU P S,SRIDHARAN S,RAMESH S.Effects of surgical stress on early nonspecific immune response in children[J].Indian J Surgery,2014,76(1):44-48.
[14]HUIBERS C J A,DE ROOS M A,ONG K H.The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer[J].Int J Colorectal Dis,2012,27(6):751-757.
[15]万红,张晓旭.T淋巴细胞相关肿瘤免疫疗法的研究进展[J].中国药房,2017,28(20):2872-2876.
[2]陈晓燕,罗金键.CXCL8在结直肠癌组织中的表达及其临床意义[J].新乡医学院学报,2018,35(6):505-508.
[3]套格苏,姜洪伟.结直肠癌常用治疗方法的研究进展[J].世界最新医学信息文摘,2018,18(55):82-84.
[4]吴亮,叶峰.腹腔镜微创术治疗结直肠癌患者的临床疗效[J].中国老年学杂志,2015,35(9):2442-2444.
[5]中华人民共和国国家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.结直肠癌诊疗规范:2015年版[J].中国实用外科杂志,2015,35(11):1177-1191.
[6]陈坤,黄秋驰.结直肠癌人群筛查研究进展[J].中国癌症防治杂志,2017,9(2):94-99.
[7]路丽娟,刘明浩,胡文炜,等.血清氨基酸和CEA/CA19-9联合测定对结直肠癌诊断的价[J].解放军医学杂志,2018,43(8):685-689.
[8]曾国祥,邬善敏.腹腔镜结直肠癌手术研究进展[J].医学综述,2017,23(3):557-560.
[9]杨钰,姜春玉.腹腔镜手术与开腹手术在结直肠癌根治术中临床疗效的对比研究[J].中国全科医学,2013,16(22):1990-1993.
[10]何毅,张鸿,何东生.腹腔镜根治术与传统开腹手术治疗结肠癌的临床效果对比分析[J].科技通报,2017,33(3):81-84.
[11]刘峰,何宋兵,郭兴坡,等.腹腔镜手术与传统开腹手术对老年结肠癌患者术后生理应激及凝血、认知功能和炎症因子的影响[J].中国老年学杂志,2018,38(2):342-344.
[12]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(5):670-673.
[13]PRABHU P S,SRIDHARAN S,RAMESH S.Effects of surgical stress on early nonspecific immune response in children[J].Indian J Surgery,2014,76(1):44-48.
[14]HUIBERS C J A,DE ROOS M A,ONG K H.The effect of the introduction of the ERAS protocol in laparoscopic total mesorectal excision for rectal cancer[J].Int J Colorectal Dis,2012,27(6):751-757.
[15]万红,张晓旭.T淋巴细胞相关肿瘤免疫疗法的研究进展[J].中国药房,2017,28(20):2872-2876.