悬吊式腹腔镜手术在大肠癌治疗中的应用及其对机体免疫功能的影响

Clinical application of Abdominal Wall Lifting laparoscopic in treatment colorectal cancer and its effects on human inunune function

目的评估悬吊式腹腔镜手术治疗结直肠癌的短期疗效及安全性。方法67例大肠癌患者根据手术方式不同分为2组，其中悬吊组37例，开腹组30例。悬吊式腹腔镜手术系指在免气腹的条件下通过腹壁悬吊来提供腹腔镜操作空间的手术方法。比较不同术式在手术时间、术中出血量、排气时间、标本长度、淋巴结总数等方面的治疗效果；以及通过酶联免疫吸附测定（ELISA）血清中IgA、IgM、IgG、C反应蛋白（CRP）含量，比较2种术式对机体免疫功能的影响。结果悬吊组、开腹组的手术时间分别为（187±23）、（185±31）min；切除标本长度分别为（21±2）、（22±3）cm；清扫淋巴结数分别为（15±4）、（17±6）枚，差异均无统计学意义；悬吊组与开腹组的术中出血量分别为（192±77）、（232±69）ml，排气时间分别为（47±9）、（64±13）h，悬吊组术中出血量明显少于开腹组，排气时间明显短于开腹组，2组比较差异有统计学意义（P〈0．05）；悬吊组、开腹组术后第3天IgM分别为（1．15±0．48）、（0．69±0．15）g/L，CRP分别为（39．4±14．5）、（58．8±10．7）mg／L；术后第5天IgM分别为（1．68±0．86）、（1．12±0．48）g／L，CRP分别为（19．5±10．6）、（38．3±11．0）mg／L，组间差异均有统计学意义（均P〈0．05）。结论悬吊式腹腔镜手术在减少手术出血量、缩短术后排气时间以及改善机体免疫功能方面明显优于开腹手术。

Objective To investigate the short-term outcomes and oncological safety of Abdominal Wall Lifting laparoscopy resection for colorectal cancer; to observe its effect on immune function. Methods Sixty-seven cases of colorectal were treated in our department,including 37 cases who received abdominal wall lifting laparoscopic surgery and 30 who received open surgery. The therapeutic efficacy, operation time, blood loss, the first exhaust time, the length of specimen and the total number of lymph nodes were compared. In addition the serum levels of IgA, IgM, IgG, C-reactive protein （CRP） in peripheral blood were assayed by ELISA, which might reflect the effects of different surgey on human immune function. Results There was no statistical difference between groups in terms of age, gender, location of tumor and TNM staging. The abdominal wall lifting laparoscopy and the open surgery, the operation time was （168 ±26）min, （166 ±31）min; the length of specimen was （21 ±2）cm, （22 ±3）cm; the total number of lymph nodes dissected was （15 ±4）, （17 ± 6） ; there was no statistical difference in the above- mentioned indexes（P 〉 0.05）. However the intra-operative blood 10ss was （194 ± 58 ）ml, （231 ± 68 ）ml and the first exhaust time after operation was （47 ± 9） h, （64 ± 13 ） h, showing significant differences （ P 〈 0.05 ）. In addi- tion, the two groups of patients had no significant difference in IgA, IgG, IgM and CRP before operation. But 3 days [IgM （1.15±0.48）, （0.69±0.15）; CRP （39.4±14.5）, （58.8 ±10.7）mg/L] and 5 days [IgM （1.68 ± 0.86）, （ 1.12 ±0.48） ; CRP（ 19.5±10.6）, （38.3 ± 11.0）mg/L] after operation the IgM and CRP had signifi- cant difference. Conclusions The two groups have no significant difference in the number of lymph nodes dissec- ted, operation time and the length of specimen. However, in the aspect of blood loss, the first exhaust time, IgM and CRP that reflect the immune response. Furthermore, the abdominal wall lifting laparoscopy group is better than the open surgery group.