小切口右半结肠切除对右半结肠癌患者术后应激、免疫功能和生存情况的影响

Effects of small incision for right hemicolectomy on postoperative stress,immune function and short-term survival in patients with right colon cancer

目的:比较小切口右半结肠切除对右半结肠癌患者术后应激、免疫功能和生存情况的影响。方法:回顾性分析2013年3月―2015年10月在我院接受治疗的87例右半结肠癌患者的临床资料。根据治疗方法的不同分为开腹组39例和小切口组48例,开腹组采用开腹手术,小切口组采用右半结肠切除术。观察两组患者围手术期情况和术后并发症情况,比较TNF-α、皮质醇、IL-6水平,以及外周血CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平,随访两组患者术后1、2、3年的复发和转移情况。结果:小切口组患者手术时间、切口长度、住院时间明显低于开腹组患者,而出血量两组患者无显著差异。并发症发生情况差异无统计学意义。术后两组患者应激反应指标较术前均显著升高,小切口组应激指标低于开腹组。术后两组患者免疫功能指标较术前均显著降低,小切口组免疫功能指标高于开腹组。两组患者术后1、2、3年的复发和转移情况无显著差异。结论:小切口右半结肠切除术能缩短手术时间、住院时间和降低医疗费用,能够减轻创伤应激反应和提高免疫功能。值得临床推广应用。

Objective To investigate the effects of small incision for right hemicolectomy on postoperative stress,immune function and short-term survival in patients with right colon cancer.Methods The clinical data of 87 patients with right colon cancer who were treated in our hospital from March 2013 to October 2015 were analyzed retrospectively.All of the patients were divided into open group(n=39)and small incision group(n=48),according to different treatment methods.The laparotomy group was treated with laparotomy,and the small incision group was treated with right hemicolectomy.The perioperative conditions and postoperative complications of the two groups were observed.The TNF-α,Cortisol,IL-6,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)of the two groups were compared.The recurrence and metastasis of the two groups were followed up for 1,2 and 3 years after operation.Results The surgical time,incision length,and hospitalization time of patients in the small incision group were significantly lower than those in the open surgery group,and there was no statistically significant difference in the incidence of complications between the two groups.The stress response indexes of patients in the two groups after operation were significantly higher than those before operation,and the small incision group were lower than the open group.After operation,the immune function indexes of the two groups were significantly lower than those before operation,and the small incision group were higher than the laparotomy group.There was no significant difference in recurrence and metastasis between the two groups at 1,2 and 3 years after operation.Conclusion Small incision right hemicolectomy can shorten the operation time,hospital stay,reduce medical costs,reduce trauma stress response and improve immune function.It is worthy of clinical application.