结直肠癌肝转移腹腔镜手术对机体炎症和免疫功能的影响

The inflammatory immune function effects of laparoscopic surgery for colorectal cancer with liver metastases

目的探讨结直肠癌肝转移腹腔镜手术对机体炎症和免疫功能的影响。方法选择2011年7月到2015年2月进行诊治的结直肠癌合并肝转移患者110例,根据随机数字表法分为治疗组与对照组,各55例。对照组采用传统开腹根治手术,治疗组采用腹腔镜下根治手术。观察两组的术中出血量、手术时间、术后住院时间和术后下床活动时间;两组患者并发症发生情况;测定免疫指标CD3^+和CD4^+;采用免疫散射比浊法测定肿瘤环死因子-α(TNF-α)、白细胞介素(IL)-6含量。结果两组患者手术时间比较差异无统计学意义(P>0.05),治疗组患者住院时间、术后下床活动时间和术中出血量显著少于对照组(P<0.05)。治疗组术后7 d内出现的吻合口漏、切口感染等并发症发生率显著低于对照组差异有统计学意义(P<0.05)。两组术后7 d的CD3^+与CD4^+值均明显低于术前(P<0.05),且治疗组CD3^+与CD4^+值升高更明显(P<0.05)。两组术后7 d的血清IL-6与TNF-α值均明显高于术前,但治疗组IL-6与TNF-α值均低于对照组(P<0.05)。结论结直肠癌肝转移腹腔镜手术具有更好的微创性与安全性,且免疫抑制与炎症反应相对比较轻,能促进机体的康复,有很好的应用价值。

Objective To investigate the inflammatory immune function effects of laparoscopic surgery for colorectal cancer with liver metastases.Methods From July 2011 to February 2015,110 cases of colorectal cancer patients with liver metastases were selected into this study,based on the random number table they were equally divided into the treatment group and the control group,each group 55 cases.The control group were performed the traditional open radical surgery,the treatment group were given laparoscopic radical surgery.The blood loss,operation time,postoperative hospital stay and postoperative ambulation time in the two groups were observed;the incidence of complications in the two groups were investigated;the immune indexes CD3^＋and CD4^＋were measured;tumor necrosis factor-α（TNF-α） and interleukin（IL）-6were determined by immunoturbidimetric turbidimetric method.Results The operative time compared the two groups were showed no significant difference,but the blood loss,postoperative ambulation time and postoperative hospital stay in the treatment group were significantly less than those of the control group（P〈0.05）.The postoperative 7 d incomplete intestinal obstruction,wound infection,lung infection,anastomotic leakage and other complications in the treatment group were significantly less than those of the control group（P〈0.05）.The postoperative 7 d values of CD3^＋and CD4^＋in the two groups were significantly lower than those of the preoperative（P〈0.05）,and the serum IL-6 and TNF-α values were significantly higher than those of the preoperative（P〈0.05）,but the postoperative 7 d values of CD3^＋and CD4^＋and serum IL-6 and TNF-α values in the treatment group compared the control group were significantly difference（P〈0.05）.Conclusion The laparoscopic surgery for colorectal cancer with liver metastases has better minimally invasive and safety,and the immune suppression and inflammation are relatively light,it can promote the rehabilitation of the body.Therefore it is worth promoting in clinical application.