腹腔镜下结直肠全系膜切除术与传统开腹手术对结直肠癌患者的免疫功能及预后比较

A Comparative Study of Immune Function and Prognosis of Laparoscopic Colorectal Total Mesorectal Excision with Traditional Open Surgery for Colorectal Cancer Patients

目的比较腹腔镜下结直肠全系膜切除术与传统开腹手术对结直肠癌患者的免疫功能及预后的影响。方法将2012年6月至2014年6月重庆市万盛经济技术开发区人民医院采取腹腔镜结直肠全系膜切除的80例结直肠癌患者作为观察组。另选取同期进行开腹结直肠全系膜切除术的80例患者作为对照组。比较两组患者手术时间、术中出血量、胃功能恢复时间、住院时间等手术一般情况,并对患者免疫功能和术后并发症发生情况进行分析。结果两组患者手术时间、术中出血量、胃功能恢复时间、住院时间等手术情况差异均无统计学意义(P>0.05);两组患者的Ig A、Ig M、Ig G组间差异无统计学意义(P>0.05)。而两组患者的C反应蛋白、IL-6术后1 d明显升高,术后7 d相较于术后1 d明显下降,但相较于术前明显升高;差异有统计学意义(P<0.05)。两组癌胚抗原(CEA)较治疗前均呈下降趋势,两组在不同时点间比较差异有统计学意义(P<0.05),而在组间及组间·时点间比较上差异无统计学意义(P>0.05);两组患者的白细胞、血小板也均无统计学意义(P>0.05)。观察组术后总并发症发生率显著低于对照组[31.3%(25/80)比87.5%(70/80),P<0.05];患者术后5年的病死率比较差异无统计学意义(P>0.05)。结论结直肠全系膜切除术较传统开腹手术术后并发症发生率低,对免疫功能的影响小于传统开腹手术,是临床结直肠癌的有效方法,值得在临床上广泛应用。

Objective To compare the effect of laparoscopic and open colorectal total mesorectal excision on immune function and prognosis of patients with colorectal cancer. Methods Total of 80 cases of colorectal cancer receiving laparoseopie total mesangial eolorectal resection in People＇s Hospital of Wansheng Economic Development District from Jun. 2012 to Jun. 2014 were included as the observation group;another 80 patients for open total mesangial colorectal resection during the same period were included as the control group. The operative time, blood loss, stomach function recovery time, hospital stay and other general surgery situation of the two groups were compared, and the postoperative complications and immune function were analyzed. Results The operative time, blood loss, stomach function recovery time, and hospital stay time of the two groups were not statistically significantly different （ P 〉 0. 05 ） ; IgA, IgM, IgG of the two groups had no statistically significant difference （P 〉 0. 05 ）. The C-reactive protein, IL-6 of the two groups were significantly increased 1 d after surgery, and decreased at 7 d after surgery compared with 1 d after surgery, but was still significantly increased compared to before surgery, the difference was statistically significant （ P 〈 0. 05 ）. Carcino-embryonic antigon of both groups was decreased compared with before treatment, the difference be- tween different time points of the two groups was statistically significant （P 〈 0. 05 ）, while the differences between groups and groups·time points were not statistically significant （ P 〉 0.05 ） ; the white blood cell, platelet of the two groups had no statistically significant differemces（ P 〉 0. 05 ）. The postoperative complication incidence of the observation group was significantly lower than the control group [ 31.3% （25/80） vs 87.5% （70/80）, P 〈 0. 05]; The 5-year case fatality rate of the two groups had no statistically significant difference （ P 〉 0.05 ）. Conclusion Laparoscopic colorectal total mesorectal excision is effective in reducing postoperative complications,with less impact on immune function than the laparotomy, thus is an effective treatment for clinical colorectal cancer,and is worth of wide application in clinical.