腹腔镜下全结肠系膜切除术治疗结肠癌疗效及对炎性因子、T淋巴细胞亚型的影响

Laparoscopic total mesorectal excision for colon cancer and its influence on inflammatory factors and T lymphocyte subtypes

目的观察腹腔镜下全肠系膜切除术治疗结肠癌的效果及其对炎性指标、应激指标、免疫指标的影响。方法选择2015年7月—2017年7月延安大学附属医院普外科收治的结肠癌患者96例,按手术方式不同分为观察组48例和对照组48例。观察组采用腹腔镜下全结肠系膜切除术,对照组采用开腹式全结肠系膜切除术。对2组患者的一般手术情况,淋巴结清扫数量情况,手术前后炎性指标(CRP、IL-6)、应激指标(HMGB-1、MCP-1、FPG、胰高血糖素),免疫指标(CD4^+、CD8^+、NK细胞)及术后并发症情况进行比较分析。结果观察组术中出血量、术后排气时间、流质饮食时间、术后引流量、术后住院时间均明显优于对照组(t=5.793、3.405、2.259、3.945、7.935,P<0.05或P<0.01),而手术时间无明显差异(t=0.294,P=0.385);观察组Ⅲ期淋巴清扫数量、阳性淋巴结清扫数量、左半结肠淋巴结清扫数量、右半结肠淋巴结清扫数量明显多于对照组(t=19.686、19.878、4.509、9.269,P均=0.000),而组间Ⅰ、Ⅱ期淋巴清扫数量无明显差异(t=1.630、1.335,P=0.051,0.053);观察组CRP、IL-6显著低于对照组(t=6.376、4.986,P均=0.000),HMGB-1、MCP-1、FPG、胰高血糖素显著低于对照组(t=21.739、17.802、9.385、18.329,P均=0.000);观察组CD4^+、CD8^+、NK细胞显著优于对照组(t=6.004、2.080、1.963,P=0.000、0.037、0.041);观察组切口感染、腹腔残余感染、肺部感染、吻合口出血发生率明显低于对照组(χ~2=7.992、5.879、3.899、4.290,P均<0.05),而2组间不完全性肠梗阻、下肢深静脉血栓无明显差异(P>0.05)。结论较之开腹手术,结肠癌行腹腔镜下全结肠系膜切除术治疗,能够减少手术创伤,降低机体应激,且更少影响免疫功能,有利于患者预后。

Objective To observe the effect of different surgical treatment of colon cancer, and compare their impact on inflammatory indicators,stress indicators and immune indicators. Methods Ninety-six patients with colon cancer were divided into observation group（48 cases） and control group（48 cases）. The patients of observation group were treated with laparoscopic complete mesocolic excision, while the patients of control group were treated with open total complete mesocolic excision. The general operation condition, the number of lymph node dissection, the indexes of inflammatory stress such as CRP, IL-6, HMGB-1, MCP-1, BG, glucagon, immune index CD4^＋, CD8^＋, NK cells and postoperative complications of two groups were compared and analyzed. Results The intraoperative bleeding,postoperative exhaust time,liquid diet time,postoperative drainage,hospital stay in the observation group were significantly lower than those in the control group（t = 5.793,t=3.405, t=2.259, t=3.945, t=7.935, P= 0.000, P=0.000, P=0.041,P=0.000, P = 0.000）, while there was no significant difference between the two groups in operation time（t = 0. 294, P = 0. 385）. The number of stage Ⅲ lymphadenectomy, the number of positive lymph node dissection, the number of left colon lymphadenectomy, the number of right colon lymphadenectomy in the observation group were significantly higher than those in the control group（t = 19. 686, t =19. 878,t =4. 509,t =9. 269,P = 0. 000,P = 0. 000,P = 0. 000. P = 0. 000）, while there was no significant difference between the two groups in I, II lymphadenectomy quantity（t = 1.630, t = 1.335, P = 0.051, P=0. 053）. The CRP, IL-6 in the observation group were significantly lower than those in the control group（t = 6. 376, t = A. 986, P = 0. 000, P = 0. 000）.The HMGB-1, MCP-1, BG, glucagon in the observation group were significantly lower than those in the control group（t =21.739, t = 17.802, t =9.385,t = 18.329,P二0.000, P=0.000, P =0.000,P= 0.000）. The CD4^＋,CD8^＋,NK cells levels in the observation group were significantly better than those in the control group（t二 2.066, t= 6.004, t =2.080, t =1.963, P = 0.021, P=0.000, P = 0.037, P =0.041）. There were incision infection,residual abdominal infection,pulmonary infection, anastomotic bleeding and other adverse complications occurred in both two groups, and the difference between the two groups were statistically significant（χ^2= 7.992,χ^2 = 5. 879,χ^2= 3.899,χ^2= 4. 290,P = 0.005,P = 0. 015,P =0.048, P = 0. 038）, but the difference between groups in the incidence of incomplete intestinal obstruction and deep vein thrombosis were not statistically significant（ χ^2= 2. 840,χ^2 = 0. 723,P =0. 092,P= 0. 395）. Conclusion Compared with laparotomy,patients with colon cancer undergo laparoscopic complete mesocolic excision can reduce surgical trauma,body irritation, and less affect the immune function, which is conducive to the prognosis of patients.