腹腔镜与开腹右半结肠癌根治术对老年患者肠道菌群和免疫功能的影响

Effects of laparoscopic vs.open surgery on intestinal microflora and immune function in aged patients after radical colectomy for right colon cancer

目的比较腹腔镜与开腹右半结肠癌根治术对老年患者肠道菌群和免疫功能的影响。方法收集2016年3月至2018年10月期间在聊城市人民医院胃肠外科接受右半结肠癌切除治疗的104例老年患者的临床资料和生物标本,分为腹腔镜组(52例)和开腹组(52例),比较2组患者术后恢复肠道菌群及免疫功能变化情况。结果腹腔镜组患者的手术时间和淋巴结清扫数目与开腹组相比差异均无统计学意义(均P>0.05),但是术中出血量[(90±42)ml比(150±50)ml,t=3.342,P<0.05],术后排气时间[(2.3±0.4)d比(3.8±1.1)d,t=1.963,P<0.05]、平均住院时间[(8.1±2.9)d比(10.6±1.3)d,t=3.547,P<0.05]及术后并发症发生率(10%比21%,P<0.05)相比差异均具有统计学意义。术后腹腔镜组双歧杆菌[(6.9±0.8)cfu/ml比(5.6±0.7)cfu/ml,t=1.131,P<0.05]和乳酸杆菌数量均[(6.7±0.6)cfu/ml比(5.2±0.7)cfu/ml,t=2.462,P<0.05]高于开腹组;术后腹腔镜组大肠杆菌[(8.0±0.5)cfu/ml比(9.5±0.5)cfu/ml,t=4.672,P<0.05],酵母菌[(4.9±0.8)cfu/ml比(6.2±0.7)cfu/ml,t=3.341,P<0.05]和葡萄球菌数量[(5.3±1.2)efu ml比(6.2±0.5)cfu/ml,t=2.571,P<0.05]均低于开腹组。腹腔镜组术后血清lL-6,TNF-α,CRP水平均低于开腹组(均P<0.05)。术后腹腔镜组外周血CD4^+细胞比例和CD4^+/CD8^+均高于开腹组(均P<0.05)。结论与开腹手术相比,老年人腹腔镜右半结肠癌根治术可以减轻患者术后菌群失调和免疫功能障碍,有利于术后早期康复。

Objective To investigate the effects of laparoscopic surgery and open surgery on intestinal flora and immune function after resection of right colon cancer in aged patients.Methods From Mar 2016 to Oct 2018,52 cases with laparoscopic surgery and 52 cases by open surgery were enrolled at Department of Gastrointestinal Surgery of Liaocheng People's Hospital.The changes of intestinal microflora and immune function were compared between these two groups.Results Between the two group,there was no significant difference in the operation time and the number of lymph node dissection(all P>0.05).Intraoperative blood loss[(90±42)ml vs.(150±50)ml,t=3.342,P<0.05],the first exhaust time[(2.3±0.4)d us.(3.8±1.l)d,t=1.963,P<0.05],hospitalization time[(8.1±2.9)d us.(10.6±1.3)d,t=3.547,P<0.05]and the incidence of postoperative complications(10%ts.21%,P<0.05)were significantly in favor of laparoscopy group.After operation,the levels of Bifidobacterium[(6.9±0.8)efu/ml vs.(5.6±0.7)cfu/ml,t=1.131,P<0.05]and Lactobacillus[(6.7±0.6)cfu/ml vs.(5.2±0.7)cfu/ml,t=2.462,P<0.05]in the laparoscopy group were statistically higher than that in the open surgery group(P<0.05).The amount of E.coli[(8.0±0.5)efu/ml vs.(9.5±0.5)cfu/ml,t=4.672,P<0.05],Yeasts[(4.9±0.8)cfu/ml rs.(6.2±0.7)efu/ml,t=3.341,P<0.05],and Staphylococcus[(5.3±1.2)cfu/ml vs.(6.2±0.5)cfu/ml,t=2.571,P<0.05]in the laparoscopy group were significantly lower than those in the open surgery group(P<0.0O5).The level of IL-6,TNF-&and CRP in the laparoscopy group were lower than those in the open surgery group(all P<0.05).The level of CD4^+cell and CD4^+cell/CD8^+cell in the laparoscopy group were higher than those in the open surgery group(P<0.05).Conclusions Laparoscopic surgery in aged patients with right colon neoplasms can alleviate postoperative intestinal microflora imbalance and immune dysfunction,helping promote recovery after surgery.