非气腹手助腹腔镜技术在结直肠癌手术中的临床应用及其对机体免疫功能的影响
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摘要
目的：研究非气腹手助腹腔镜技术在结直肠癌中的临床应用前景及其对人体免疫功能的影响。
材料与方法：对比研究非气腹手助腹腔镜手术、CO_2气腹腹腔镜手术及开腹手术，从早期的胆囊切除手术的临床应用过渡到结直肠癌根治手术，分别从手术时间、住院费用、住院天数、病理分型、根治范围等进行对比研究，然后从人体外周血淋巴细胞、红细胞等免疫功能方面作进一步分析，以确定非气腹手助腹腔镜手术在临床中的应用价值。
结果：非气腹腹腔镜手术在患者主观反应、血液动力学变化、呼吸功能、心肌酶学变化等方面，与气腹腹腔镜手术比较在胆囊切除术中有明显的优越性。
在结直肠癌手术中，非气腹手助腹腔镜手术、CO_2气腹腹腔镜手术和开腹手术比较，其在手术时间、住院费用、住院天数、病理分型、根治范围等方面有明显差异，非气腹手助腹腔镜手术对机体干扰少，创伤少、术后疼痛轻、功能恢复快、术后并发症少、住院时间短。
深入研究三种术式对人体免疫功能的影响，非气腹手助腹腔镜手术在外周血T淋巴细胞亚群数量和分类的变化、RC3bRR(红细胞Ⅰ型补体受体花环率)和RICR(免疫复合物花环率)、RFER(红细胞免疫促进因子)和RFIR(红细胞免疫抑制因子)、血浆IL-6、CRP等急性反应指标含量分析均有明显差异。
结论：自制腹壁提升器LC和CO2气腹LC在手术效果、术后住院时间等方面比较都没有显著的差异性；非气腹腹腔镜可以避免高碳酸血症和呼吸性酸中毒，腹壁提升非气腹装置在有心肺疾患和高危患者腹腔镜手术中，具有CO2气腹腹腔镜无法比拟的优点。
非气腹手助腹腔镜结直肠癌手术，对比CO2气腹腹腔镜手术，由于采用了非气腹装置，避免了高压气腹的并发症，手助后增加探查的准确性，操作更方便，保证了肿瘤切除的彻底性，无论是手术切除长度还是淋巴结清扫范围都有较明显的优势，更接近传统的开腹手术，提高了手术的安全性。且在手术疗效上明显比开腹手术优越，短期的随访结果和开腹无明显差异，长期的疗效需进一步观察。
通过非气腹手助腹腔镜、CO2气腹腹腔镜和开腹手术创伤后出现的急性期反应(APR)和红细胞免疫功能的检测，中性粒细胞计数、IL-6，NK，CRP浓度等APR指标检测，发现非气腹手助腹腔镜结直肠癌手术术后中性粒细胞(N)／淋巴细胞(L)、CRP、IL-6等免疫指标的变化情况较腹腔镜组、开腹组有明显区别，为评价此手术技术是否较传统方法优越和临床免疫调节治疗提供依据。
Objective: To investigate gasless hand-assisted laparoscopic surgery on the colorectal malignancy and its effection on immune function of human.
Materials and Methods: Campare gasless hand-assisted laparoscopic surgery, carbon dioxide pneumoperitoneum laparoscopic surgery and operation on Cholecystectomy, colorectal resections, according to the study of operation time, expense in hospital, number of days, pathologic type, extension of radical cure, and analysis of the blood lymphocytes, immune function of erythrocyte, we could ascertain the application value of gasless hand-assisted laparoscopic surgery.
Results: Gasless hand-assisted laparoscopic surgery had no obvious difference with laparoscopic Cholecystectomy on subjective sensation, hemodynamic changes, breathing function, cardiac muscle enzymologic changes.
In the process of colorectal cancer resections, gasless hand-assisted laparoscopic surgery had obvious difference with carbon dioxide pneumoperitoneum laparoscopic surgery and operation on operation time, expense in hospital, number of days, pathologic type, extension of radical cure, and analysis of the blood lymphocytes, immune function of erythrocyte because gasless assisted laparoscopic surgery had litter disturb, litter wound, in litter pain, fast function recover, litter complications and hospital stay days.
Penetrate into the affections of human immune functions by above three kinds of cure pattern, gasless hand-assisted laparoscopic surgery had obvious difference with the others on blood lymphocytes, immune function of erythrocytes RC3bRR, RICR, RFER, RFIR, IL-6、C-reactive protein(CRP) and so on.
Conclusions: The self-made Abdominal Wall Lifting laparoscopic surgery had no obvious difference with carbon dioxide pneumoperitoneum laparoscopic surgery on the fact of operation effection, post-operation hospital stay time.
Gastess hand-assisted laparoscopic surgery could avoid of hypercapnia and respiratory acidosis. Abdominal Wall Lifting installation Play an important role on laparoscopic surgery with heart and lung disease and high dangerous patient, had uncompleted advantage with carbon dioxide pneumoperitoneum laparoscopic surgery.
Because of the adoption with Gasless hand-assisted technique, we found that the resection effect was promoted great. No matter the resection bowel length or lymph node clearing had obvious dominance, and it had reached the same effect between those two operation groups. There are obvious superiority on operation effect compared with abdomen opening surgery, had no difference on short time follow up, but the long-time curative effect need observed furthermore.
Compared with acute-phase reaction and erythrocytic immune function, neutrophilic counts, interleukin-6, natural killer cells, C-reaction protein between gasless hand-assisted laparoscopic surgery and carbon dioxide pneumoperitoneum laparoscopic surgery, we found there were obvious difference on N/L rate, CRP, IL-6, Which provided evidence for evaluate the gasless hand-assisted laparoscopic technique superiority to the traditional surgery, and treatment for clinical immune modulation.
材料与方法：对比研究非气腹手助腹腔镜手术、CO_2气腹腹腔镜手术及开腹手术，从早期的胆囊切除手术的临床应用过渡到结直肠癌根治手术，分别从手术时间、住院费用、住院天数、病理分型、根治范围等进行对比研究，然后从人体外周血淋巴细胞、红细胞等免疫功能方面作进一步分析，以确定非气腹手助腹腔镜手术在临床中的应用价值。
结果：非气腹腹腔镜手术在患者主观反应、血液动力学变化、呼吸功能、心肌酶学变化等方面，与气腹腹腔镜手术比较在胆囊切除术中有明显的优越性。
在结直肠癌手术中，非气腹手助腹腔镜手术、CO_2气腹腹腔镜手术和开腹手术比较，其在手术时间、住院费用、住院天数、病理分型、根治范围等方面有明显差异，非气腹手助腹腔镜手术对机体干扰少，创伤少、术后疼痛轻、功能恢复快、术后并发症少、住院时间短。
深入研究三种术式对人体免疫功能的影响，非气腹手助腹腔镜手术在外周血T淋巴细胞亚群数量和分类的变化、RC3bRR(红细胞Ⅰ型补体受体花环率)和RICR(免疫复合物花环率)、RFER(红细胞免疫促进因子)和RFIR(红细胞免疫抑制因子)、血浆IL-6、CRP等急性反应指标含量分析均有明显差异。
结论：自制腹壁提升器LC和CO2气腹LC在手术效果、术后住院时间等方面比较都没有显著的差异性；非气腹腹腔镜可以避免高碳酸血症和呼吸性酸中毒，腹壁提升非气腹装置在有心肺疾患和高危患者腹腔镜手术中，具有CO2气腹腹腔镜无法比拟的优点。
非气腹手助腹腔镜结直肠癌手术，对比CO2气腹腹腔镜手术，由于采用了非气腹装置，避免了高压气腹的并发症，手助后增加探查的准确性，操作更方便，保证了肿瘤切除的彻底性，无论是手术切除长度还是淋巴结清扫范围都有较明显的优势，更接近传统的开腹手术，提高了手术的安全性。且在手术疗效上明显比开腹手术优越，短期的随访结果和开腹无明显差异，长期的疗效需进一步观察。
通过非气腹手助腹腔镜、CO2气腹腹腔镜和开腹手术创伤后出现的急性期反应(APR)和红细胞免疫功能的检测，中性粒细胞计数、IL-6，NK，CRP浓度等APR指标检测，发现非气腹手助腹腔镜结直肠癌手术术后中性粒细胞(N)／淋巴细胞(L)、CRP、IL-6等免疫指标的变化情况较腹腔镜组、开腹组有明显区别，为评价此手术技术是否较传统方法优越和临床免疫调节治疗提供依据。
Objective: To investigate gasless hand-assisted laparoscopic surgery on the colorectal malignancy and its effection on immune function of human.
Materials and Methods: Campare gasless hand-assisted laparoscopic surgery, carbon dioxide pneumoperitoneum laparoscopic surgery and operation on Cholecystectomy, colorectal resections, according to the study of operation time, expense in hospital, number of days, pathologic type, extension of radical cure, and analysis of the blood lymphocytes, immune function of erythrocyte, we could ascertain the application value of gasless hand-assisted laparoscopic surgery.
Results: Gasless hand-assisted laparoscopic surgery had no obvious difference with laparoscopic Cholecystectomy on subjective sensation, hemodynamic changes, breathing function, cardiac muscle enzymologic changes.
In the process of colorectal cancer resections, gasless hand-assisted laparoscopic surgery had obvious difference with carbon dioxide pneumoperitoneum laparoscopic surgery and operation on operation time, expense in hospital, number of days, pathologic type, extension of radical cure, and analysis of the blood lymphocytes, immune function of erythrocyte because gasless assisted laparoscopic surgery had litter disturb, litter wound, in litter pain, fast function recover, litter complications and hospital stay days.
Penetrate into the affections of human immune functions by above three kinds of cure pattern, gasless hand-assisted laparoscopic surgery had obvious difference with the others on blood lymphocytes, immune function of erythrocytes RC3bRR, RICR, RFER, RFIR, IL-6、C-reactive protein(CRP) and so on.
Conclusions: The self-made Abdominal Wall Lifting laparoscopic surgery had no obvious difference with carbon dioxide pneumoperitoneum laparoscopic surgery on the fact of operation effection, post-operation hospital stay time.
Gastess hand-assisted laparoscopic surgery could avoid of hypercapnia and respiratory acidosis. Abdominal Wall Lifting installation Play an important role on laparoscopic surgery with heart and lung disease and high dangerous patient, had uncompleted advantage with carbon dioxide pneumoperitoneum laparoscopic surgery.
Because of the adoption with Gasless hand-assisted technique, we found that the resection effect was promoted great. No matter the resection bowel length or lymph node clearing had obvious dominance, and it had reached the same effect between those two operation groups. There are obvious superiority on operation effect compared with abdomen opening surgery, had no difference on short time follow up, but the long-time curative effect need observed furthermore.
Compared with acute-phase reaction and erythrocytic immune function, neutrophilic counts, interleukin-6, natural killer cells, C-reaction protein between gasless hand-assisted laparoscopic surgery and carbon dioxide pneumoperitoneum laparoscopic surgery, we found there were obvious difference on N/L rate, CRP, IL-6, Which provided evidence for evaluate the gasless hand-assisted laparoscopic technique superiority to the traditional surgery, and treatment for clinical immune modulation.
引文
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