腹腔镜联合结肠镜行结肠癌根治术对结肠癌患者Th1、Th2细胞因子的影响

The Influence of Laparoscopy Combined with Colonoscopy Assisting Colon Carcinoma Radical Operation on Cytokines Including Th1 and Th2 in Patients with Colon Cancer

目的探讨腹腔镜联合结肠镜行结肠癌根治术的疗效和对免疫因子调控的影响。方法选取行结肠癌根治术的结肠癌患者80例,随机分为两组,每组40例,传统组(A组)患者传统开腹手术,内镜组(B组)患者在腹腔镜联合结肠镜行结肠癌根治术,比较两组患者的临床疗效和术后不良反应发生情况,检测患者术前术后外周血Th1细胞和Th2细胞的含量和血清中IL-2、TNF-α、IL-6以及IL-10等细胞因子的分泌水平。结果 B组患者与A组患者相比较,术中出血量明显减少(P<0.05),术后排气时间和住院时间明显缩短(P<0.05),术后需要镇痛治疗的患者以及术后发生不良反应的患者明显减少(P<0.05);比较两组患者术前术后外周血Th1细胞和Th2细胞的含量发现,A组患者Th1细胞含量下降(P<0.05),Th2细胞含量显著升高(P<0.05),Th1/Th2的比值显著降低(P<0.05);B组患者术后Th1的细胞含量与A组比较显著较高(P<0.05),Th2的细胞含量与A组患者相比较明显较低(P<0.05),Th1/Th2比值与A组比较明显较高(P<0.05);术后1天和术后5天B组患者IL-2和TNF-α的含量显著高于A组患者,IL-6和IL-10的含量显著低于A组患者。结论腹腔镜联合结肠镜行结肠癌根治术可以有效改善患者手术疗效,降低对患者免疫调节系统的影响和术后不良反应的发生率,有助于患者术后恢复,值得临床推广应用。

Objective To explore the curative effect of laparoscopy combined with colonoscopy assisting colon carcinoma radical operation and its influence on regulation of cytokines. Methods 80 patients undergoing colon carcinoma radical operation were enrolled and divided into 2 groups randomly, the patients in the traditional group （ group A, n = 40 ） received traditional open surgery, and the patients in endoscopic group （ group B, n = 40 ） received colon carcinoma radical operation with laparoscopy and colonoseopy. The clinical curative and the incidence of postoperative adverse reactions were compared between group A and group B. And the level of Thl cells,Th2 cells in the peripheral blood and IL-2 ,TNF-,IL-6 ,IL-10 in the serum were detected and com- pared before and after operation. Results Intraoperative blood loss, postoperative analgesia and adverse reactions in group B were significantly lower than that of group A （ P 〈 0.05 ）, and postoperative exhaust time and hospitalization in group B were siguifi- candy shorter than that in group A （P 〈 0.05） ;It was found by comparing contents of Thl and Th2 cells in the peripheral blood in patients of the 2 groups before and after operation that content of Thl cells was reduced（P 〈0. 05） ,content of Th2 cells was dramatically increased（P 〈0.05） ,ratio of Thl and Th2 was significantly reduced（P 〈0.05） in the patients of group A. After op- eration, compared with the patients of A group, the content of Thl ceils was higher（ P 〈 0.05 ）, content of Th2 ceils was significant lower（ P 〈 0.05 ）, ratio of Thl and Th2 was higher（ P 〈 0.05 ） in the patients of group B. The level of IL-2 and TNF-ot in group B in postoperative 1 day and 5 day were significantly higher than those of group A,and the content of IL-6 and IL-10 in the group B was signifieandy lower than that of group A. Conclusion Laparoscopy combined with colonoscopy assisting the colon carcinoma radical operation deserved popularization in clinic, which not only improved the curative of operation, but also decreased the influ- ence of surgery on immune regulation system and incidence of postoperative adverse reactions, and contributed to the recovery of patients undergoing colon carcinoma radical operation.