腹腔镜手术用于结肠癌对患者免疫功能、恢复效果的研究

Influence of laparoscopic surgery on the immune function and recovery effect of patients with colon cancer

目的探讨腹腔镜手术用于结肠癌对患者免疫功能、恢复速度的影响。方法选取2014年4月至2019年2月梅州市梅县区中医医院行结肠癌根治术患者80例作为研究对象,根据手术方法分为两组,其中传统组给予传统开腹手术,腹腔镜组给予腹腔镜手术。比较两组患者手术时间、术中出血量、切口长度、淋巴结清扫数、术后肠胃恢复时间、住院时间及并发症情况。检测两组患者术前、术后72 h时免疫功能指标、炎症因子的变化情况。结果腹腔镜组手术时间(152.45±18.72)min、肠鸣音恢复时间(23.02±4.17)h、术后排气时间(38.26±4.78)h、术后排便时间(114.02±18.79)h、住院天数(6.11±1.97)d及切口长度(6.82±0.47)cm短于传统组,术中出血量(102.74±22.34)ml少于传统组,术后2周内的并发症发生率(7.50%)低于传统组,差异有统计学意义(P<0.05);淋巴结清扫数(15.52±3.01)枚与传统组比较,差异无统计学意义(P>0.05)。两组术前免疫功能指标、炎症因子比较,差异无统计学意义(P>0.05)。两组术后72 h时辅助性T细胞2(Th2)比例、调节性T细胞(Treg)比例及肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-10(IL-10)均较术前上升,辅助性T细胞1(Th1)比例较术前下降,腹腔镜组术后72 h时Th1比例高于传统组,Th2比例、Treg比例、TNF-α、CRP、IL-10水平低于传统组,差异有统计学意义(P<0.05)。结论腹腔镜手术用于结肠癌时间短,创伤小,术后胃肠功能恢复快,并发症少,对机体应激及免疫功能影响较小。

Objective To investigate the effect of laparoscopic surgery on immune function and recovery rate of colon cancer patients.Methods From April 2014 to February 2019,80 patients undergoing radical resection of colon cancer in Traditional Chinese Medicine Hospital of Mei County were divided into two groups.The traditional group was given traditional laparotomy,and the laparoscopy group was given laparoscopic surgery.The operation time,intraoperative blood loss,incision length,lymph node clearance,postoperative gastrointestinal recovery time,hospitalization time and complications were compared between the two groups.The changes of immune function and inflammatory factors were measured before and 72 h after operation.Results In the laparoscopy group,the operation time of was(152.45±18.72)min,the recovery time of intestinal sound was(23.02±4.17)h,the postoperative exhaust time was(38.26±4.78)h,the postoperative defecation time was(114.02±18.79)h,the hospitalization time was(6.11±1.97)d,the incision length was(6.82±0.47)cm,which were all shorter than those of the traditional group(all P<0.05).In the laparoscopy group,the intraoperative bleeding volume was(102.74±22.34)ml,the complications rate within 2 weeks after operation was 7.50%,which were all lower than those in the traditional group(all P<0.05).The number of lymph node dissection was(15.52±3.01)in the laparoscopic group,and was(15.24±2.51)in the traditional group,and there was no significant difference between the two groups(P>0.05).There was no significant difference in preoperative immune function and inflammation factor between the two groups(P>0.05).The helper T cell 2(Th2)ratio,regulatory T cell(Treg)ratio and tumor necrosis factor-α(TNF-α),C reactive protein(CRP),IL-10 of 72 h after operation were higher than those before operation.At 72 h after operation,the proportion of helper T cell 1(Th1)in the laparoscopic group was higher than that in the traditional group,and the proportion of Th2,the proportion of Treg and the level of TNF-α,CRP,IL-10 were lower than those in the traditional group(P<0.05).Conclusion Laparoscopic surgery is used for colon cancer with short time,less trauma,quick recovery of gastrointestinal function after operation,less complications,and less effect on body stress and immune function.