开放性与腹腔镜直肠癌根治术后感染病原菌与并发症比较研究

Pathogenic bacteria causing postoperative infections after open and laparoscopic radical resection of colorectal cancer and comparative research on related complications

目的研究分析腹腔镜与传统开腹直肠癌根治术后并发症情况及影响因素,术后出现感染的病原菌分布及免疫功能变化。方法选取2014年6月-2016年6月医院收治的行直肠癌根治术治疗患者90例,根据手术方法不同将所有患者分为两组,其中A组47例行腹腔镜直肠癌根治术治疗;B组43例行传统开腹直肠癌根治术治疗。治疗医师于术后1个月观察并记录两组患者的并发症情况,同时进行相关影响因素研究分析;对患者手术部位的病原菌分布及免疫功能变化进行检测并分析。结果术后1个月,两组患者术后并发症总发生率A组为38.30%,B组为39.53%,比较差异无统计学意义;两组患者术后并发症的发生和肿瘤下缘与肛门间距具有相关性,而手术方式、性别、年龄、TNM(0-Ⅲ期)分期等因素与直肠癌术后并发症的发生无显著关联;术后感染率A组患者为19.15%,B组为32.56%,两组患者感染率比较,差异有统计学意义(P<0.05);A组患者分离出病原菌28株,B组患者分离出病原菌41株;两组患者术后IFN-γ、IL-2水平值均显著高于术前,而IL-10水平值均显著低于术前,差异有统计学意义(P<0.05);A组术后IFN-γ、IL-2水平值略高于B组,而IL-10水平值略低于B组,差异有统计学意义(P<0.05)。结论对于直肠癌治疗,腹腔镜与传统开腹根治术均是主要的临床治疗方法,虽然腹腔镜技术具有其突出的优点,但腹腔镜根治术并不能完全确定为直肠癌治疗的统一标准化方法,随着腹腔镜技术的不断提高和临床医师操作技术的不断熟练,其仍是治疗直肠癌的首选术式。

OBJECTIVE To investigate and analyze complications and influencing factors after laparoscope and traditional open radical resection of colorectal cancer as well as the pathogenic bacteria distribution and changes of immunity after operation.METHODS A total of 90 patients with radical operations for colorectal cancer in our hospital from Jun.2014 to Jun.2016 were selected,which were divided into two groups according to different operation methods,in which group A had 47 patients treated with laparoscopic radical resection of colorectal cancer,and group B had 43 patients treated with traditional open radical resection of colorectal cancer.The complications of the two groups of patients after one month of the operation were observed and recorded,at the same time,the related influencing factors were analyzed,and the pathogenic bacteria distribution and immunity changes of the operation sites were detected and analyzed.RESULTS The overall incidence rates of postoperative complications in the two groups were 38.3% for group A and 39.53% for group B,and there was no significant difference.There were correlation between incidence rate of complications and gap between lower tumor edge and anus after operation,while there was no significant correlation between operation methods,genders,age,TNM （0-Ⅲ period） period and incidence rate of complications after colorectal cancer operation.The postoperative infection rate of group A was 19.15% and that of group B was 32.56%,and the difference was with ignificant （P〈0.05）.There were 28 strains and 41 strains of pathogenic bacteria isolated from group A and group B respectively.The IFN-γand IL-2 levels of the two groups after operation were significantly higher than those before operation,while the IL-10 level was significantly lower than that before operation （P〈0.05）.The IFN-γ and IL 2 levels of group A after operation were significantly higher than those of group B,while the IL-10 level was significantly lower than that of group B （P〈0.05）.CONCLUSION Both laparoscope and traditional open radical operation are main clinical treatment methods for colorectal cancer.Laparoscope technology is with outstanding advantages,but laparoscopic radical operation cannot be confirmed as the unified standardized method for colorectal cancer treatment.With the continuous improvement of laparoscope technology and increasingly proficient operation skills of clinicians,it is also the preferred operation method for the treatment of colorectal cancer.