结肠镜联合腹腔镜根治术对老年结直肠癌炎性因子、T淋巴细胞亚群的影响

Effect of colonoscopy combined with laparoscopy on the inflammatory factors and T lymphocyte subgroups in elderly patients with colorectal cancer

目的分析行结肠镜联合腹腔镜对根治术老年结直肠癌病人炎性因子、T淋巴细胞亚群的影响。方法选取2014年9月至2017年3月在南阳医学高等专科学校第一附属医院诊断且符合纳入标准的80例结直肠癌老年病人为研究对象,按照随机数字表法将其分为研究组和对照组,每组各40例,对照组病人采用腹腔镜结直肠癌根治术治疗,研究组病人采用结肠镜联合腹腔镜结直肠癌根治术治疗,比较两组病人术前、术后1 d、术后5 d的炎性因子及T淋巴细胞亚群水平。结果研究组病人术后1 d、5 d的肿瘤坏死因子-α(TNF-α)水平[(104.27±20.42)ng/L、(91.26±13.01)ng/L]显著低于对照组[(125.32±27.08)ng/L、(104.30±20.39) ng/L](均P=0.001);两组病人的TNF-α、白细胞介素(IL)-6、IL-8及T淋巴细胞亚群CD■、CD■、CD■水平存在组间效应(F=5.894,P=0.017;F=14.683,P=0.000;F=216.181,P=0.000;F=64.658,P=0.000;F=177.909,P=0.000;F=55.526,P=0.000),且术后1d、5d研究组各炎性因子水平显著低于对照组(P<0.05),T淋巴细胞亚群水平显著高于对照组(P<0.05);两组病人的TNF-α、IL-6、IL-8及T淋巴细胞亚群CD■、CD■、CD■水平存在时间效应(F=65.946,P=0.000;F=113.858,P=0.000;F=265.156,P=0.000;F=324.475,P=0.000;F=326.190,P=0.000;F=348.601,P=0.000),且术后1 d、5 d两组各炎性因子水平均显著高于术前(P<0.05),T淋巴细胞亚群水平显著低于术前(P<0.05);两组病人各指标的组间因素与时间因素存在交互效应(F=5.253,P=0.006;F=5.262,P=0.006;F=34.329,P=0.000;F=15.709,P=0.000;F=32.101,P=0.000;F=11.298,P=0.000)。结论结肠镜联合腹腔镜根治术对老年结直肠癌病人的炎症反应及免疫功能影响较小。

Objective To analyze the effect of colonoscopy combined with laparoscopy on the inflammatory factors and T lymphocyte subgroups in elderly patients with colorectal cancer.Methods Eighty elderly patients with colorectal cancer who were diagnosed and met the inclusion criteria in The first affiliated Hospital of Nanyang Medical College from September 2014 to March 2017 were selected and assigned into study group and control group according to random number table method,with 40 patients in each group.The control group was treated with laparoscopic colorectal cancer radical surgery,and the study group was treated with laparoscopy combined with colonoscopy radical surgery.The level of inflammatory factors and T lymphocyte subgroups were compared between the two groups in preoperative,one day and five days after surgery.Results The level of tumor necrosis factor-α(TNF-α)in one day and five days after surgery of the study group were significantly lower than those of preoperative[(104.27±20.42)ng/L vs.(125.32±27.08)ng/L;(91.26±13.01)ng/L vs.(104.30±20.39)ng/L;all P=0.001].The levels of TNF-α,interleukin(IL-6),IL-8,T lymphocyte subsets CD3^+,CD 4^+,and CD 8^+in the two groups showed an grouping effect(F=5.894,P=0.017;F=14.683,P=0.000;F=216.181,P=0.000;F=64.658,P=0.000;F=177.909,P=0.000;F=55.526,P=0.000),the levels of inflammatory factors in the study group were significantly lower than those in the control group at 1 d and 5 d after surgery(P<0.05),and the levels of T lymphocyte subsets were significantly higher than those in the control group(P<0.05);the levels of TNF-α,IL-6,IL-8 and T lymphocyte subsets CD 3^+,CD 4^+,and CD 8^+in the two groups had an grouping effect(F=65.946,P=0.000;F=113.858,P=0.000;F=265.156,P=0.000;F=324.475,P=0.000;F=326.190,P=0.000;F=348.601,P=0.000),and the levels of inflammatory factors in the two groups were significantly higher at 1 d and 5 d after surgery(P<0.05),while the levels of T lymphocyte subsets were significantly lower than those before surgery(P<0.05).Furthermore,there was interaction between the time and the group factors of each index(F=5.253,P=0.006;F=5.262,P=0.006;F=34.329,P=0.000;F=15.709,P=0.000;F=32.101,P=0.000;F=11.298,P=0.000).Conclusion The colonoscopy combined with laparoscopy colorectal cancer radical surgery has little effect on inflammatory response and immune function in elderly patients with colorectal cancer.