腹腔镜低位直肠癌手术治疗对患者临床结局、免疫功能及血miR-21水平的影响

Effects of laparoscopic surgery for low rectal cancer on clinical outcomes,immune function and serum miR-21 levels

目的探讨腹腔镜低位直肠癌手术治疗对患者临床结局、免疫功能及血浆miR-21水平的影响。方法选取2017年3月~2019年4月在我院治疗的68例直肠癌患者作为研究对象,其中进行传统开放手术的34例为开放组,进行腹腔镜手术的34例患者为腹腔镜组。比较两组患者手术及术后情况,入院时、出院时检测并比较两组患者的miR-21及免疫功能,统计并分析两组患者的术后并发症情况。结果腹腔镜组的手术时间、术中出血量、术后排气时间、术后进食时间、术后排尿时间及住院天数均小于开放组(P<0.05);两组的CD3+、CD4+、CD4+/CD8+均于治疗后出现先降低后上升的趋势,且在不同时间点、不同组间及不同时间点×不同组间均表现出统计学差异(P<0.05),在术后1 d和术后3 d均为腹腔镜组高于开放组(P<0.05);两组的miR-21均于治疗后出现下降趋势,且在不同时间点、不同组间及不同时间点×不同组间均表现出统计学差异(P<0.05),在术后1 d和术后3 d均为腹腔镜组低于开放组(P<0.05);腹腔镜组和开放组的术后并发症发生率分别为5.88%和23.52%,腹腔镜组低于开放组(χ2=4.221,P=0.021)。结论直肠癌患者采用腹腔镜低位直肠癌手术治疗,患者的手术及术后情况较好,可显著改善患者的miR-21水平,并提高免疫功能,具有较好的疗效。

Objective To investigate the effect of laparoscopic surgery for low rectal cancer on clinical outcome,immune function and serum miR-21 level.Methods 68 patients with rectal cancer treated in Jiangsu Shengze Hospital Affiliated to Nanjing Medical University between March 2017 and April 2019 were selected as the research subjects,of whom 34 patients who underwent traditional open surgery were the open group,and 34 patients who underwent laparoscopic surgery were the laparoscopic group.The surgical and postoperative conditions of the two groups were compared.The miR-21 and immune function were compared at the time of admission and discharge,and the postoperative complications of the two groups were statistically analyzed.Results The operation time,intraoperative bleeding amount,postoperative exsufflation time,postoperative feeding time,postoperative urination time,and length of hospital stay in the laparoscopic group were less than those in the open group(P<0.05);CD3+,CD4+,CD4+/CD8+in the two groups showed a trend of first decrease and then increase after treatment,and there were statistical differences at different time points,between different groups,and at different time points and between different groups(P<0.05).CD3+,CD4+,CD4+/CD8+at 1 and 3 days after surgery in the laparoscopic group were higher than in the open group(P<0.05);miR-21 in both groups showed a downward trend after treatment,and there were statistical differences at different time points,between different groups,and at different time points and between different groups(P<0.05).The level of miR-21 in the laparoscopic group was lower than that in the open group at 1 and 3 days after surgery(P<0.05).The incidence of postoperative complications was 5.88%and 23.52%in the laparoscopic and open groups,respectively,and the difference was statistically significant(χ2=4.221,P=0.039).Conclusion Laparoscopic surgery for low rectal cancer is effective and can significantly improve the miR-21 level and immune function of patients.