腹腔镜手术治疗结肠癌的围术期应激反应及免疫功能观察

Observation on perioperative stress reactions and immune function of laparoscopic surgery in the treatment of colon cancer

目的探讨腹腔镜手术对结肠癌患者围术期应激反应及免疫功能的影响。方法选取行外科手术治疗的108例结肠癌患者为研究对象,根据其入院顺序分成开腹组(n=54)和腹腔镜组(n=54)两组。观察对比两组患者术程、总住院时间、胃肠功能恢复时间等围术期指标差异,记录其术前24 h(T_0)、术后即刻(T_1)、术后24 h(T_2)、术后72 h(T_3)等时间点应激指标及免疫指标变化情况,分析其术后并发症发生率、3年存生存率及复发率差异。结果(1)两组患者在平均术程对比差异无统计学意义(P>0.05);腹腔镜组术后胃肠功能恢复时间及总住院时间均显著短于开腹组(P<0.05);(2)T_1-T_2时,两组患者中性粒细胞、皮质醇、肾上腺素、血糖、C反应蛋白等应激指标均较T0时显著提升(P<0.05),CD3+、CD4+、CD8+、CD4+/CD8+等免疫指标则较T_0时显著降低(P<0.05);其中腹腔镜组上述指标变化幅度明显小于开腹组(P<0.05);(3)两组患者在3年生存率及复发率对比上均无统计学意义(P>0.05);腹腔镜组术后并发症发生率为3.7%,显著低于开腹组的14.8%(P<0.05)。结论腹腔镜结肠癌根治术具有微创、恢复期短、预后良好等优势,患者围术期应激反应轻微且免疫功能不良影响较小,安全性突出。

Objective To investigate the effects of laparoscopic surgery on perioperative stress reactions and immune function in patients with colon cancer.Methods 108 cases of patients with colon cancer treated by surgery were selected as the research objects.According to the order of admission,they were divided into the open group(n=54) and the laparoscopic group(n=54) of two groups.The differences in surgery procedure,total length of hospital stay,recovery time of gastrointestinal function and other perioperative indicators were observed and compared between the two groups.The changes of stress indexes and immune indexes at time points such as 24 h before sugery(T_0),immediate after surgery(T_1),24 h after surgery(T_2) and 72 h after surgery(T_3) were recorded.The incidence of postoperative complications,three-year survival rates and recurrence rates were analyzed.Results(1)There was no statistical significance in the comparison of mean surgery procedure between the two groups(P >0.05);The recovery time of gastrointestinal function and total length of hospital stay of the laparoscopic group was significantly shorter than that of the open group(P <0.05);(2)At T_1-T_2,neutrophils,cortisol,epinephrine,blood glucose,C reactive protein and other stress indicators in the two groups were significantly higher than those at T0(P <0.05) while CD3^+,CD4^+,CD8^+,CD4^+/CD8^+and other immune parameters were significantly lower than those at T0(P <0.05);The changes of above indexes in the laparoscopic group were significantly smaller than those in the open group(P <0.05);(3)The differences in 3-year survival rate and recurrence rate between the two groups were not statistically significant(P >0.05);The incidence of postoperative complications in the laparoscopic group(3.7%) was significantly lower than that in the open group(14.8%)(P<0.05).Conclusion Laparoscopic radical resection of colon cancer has advantages such as minimally invasive,short recovery time and good prognosis.The perioperative stress reactions in patients are mild.The effects on immune function are small and safety is significant.