结直肠癌标本经自然腔道取出术对患者氧化应激及免疫功能影响

Effect of natural orifice specimen extraction after laparoscopic colorectal resections on oxidative stress and immune function of patients with colorectal cancer

目的比较传统腹腔镜结直肠癌根治术(LACR),全腹腔镜结直肠癌根治术经自然腔道取标本手术(NOSES),两种方式对患者术后体内微环境氧化应激及免疫功能的影响。方法选择2018年9月—2020年7月我院结直肠癌手术患者48例,按照手术方式分为观察组(NOSES组)22例和对照组(LACR组)26例,对两组手术患者氧化应激及免疫学指标均通过检测患者术前1天(D1)、术后第2天(D2)及术后第7天(D3)血液中超氧化物歧化酶(SOD)、丙二醛(MDA)、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、免疫球蛋白(IgA、IgM、IgG)和补体(C3、C4)结果评估。结果两组患者组间比较术前1天(D1)时患者血清MDA、SOD、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、IgA、IgM、IgG、C3、C4值差异无统计学意义(P>0.05);术后第2天(D2)时观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IgM、IgG、IgA、SOD值均较对照组高(P<0.05),观察组MDA值低于对照组(P<0.05);术后第7天(D3)时观察组CD3^(+)、CD4^(+)、C3、C4、IgM、IgA值与对照组差异无统计学意义(P>0.05),观察组CD4^(+)/CD8^(+)、IgG、SOD值高于对照组(P<0.05),观察组MDA值低于对照组(P<0.05)。结论NOSES较LACR术对患者术后氧化应激反应和对患者免疫系统的影响更小,更有利于患者术后恢复。

Objective To compare the effects of conventional laparoscopic colorectal resections(LACR)and natural orifice specimen extraction surgery(NOSES)after total laparoscopic colorectal resections on the microenvironmental oxidative stress and immune function of patients.Methods A total of 48 patients with colorectal cancer,who underwent surgery in our hospital from September 2018 to July 2020,were selected and divided into an observation group(22 patients for NOSES)and a control group(26 patients for LACR)according to the surgical methods.We detected the levels of superoxide dismutase(SOD),malondialdehyde(MDA),T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),immunoglobulin(IgA,IgM,IgG)and complements(C3,C4)in the patients’blood on the day before surgery(D1),the second day after surgery(D2)and the seventh day after surgery(D3)for evaluation of the oxidative stress and immunological indicators of two groups.Results There was no significant difference in serum MDA,SOD,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),IgA,IgM,IgG,C3,C4 between two groups at D1(P>0.05).The levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IgM,IgG,IgA and SOD in the observation group were higher than those of the control group at D2(P<0.05),while MDA was lower than that of the control group(P<0.05).There was no significant difference in the levels of CD3^(+),CD4^(+),C3,C4,IgM and IgA between the observation group and the control group at D3(P>0.05).At D3,the levels of CD4^(+)/CD8^(+),IgG and SOD in the observation group were higher than those of the control group(P<0.05),and MDA was lower than that of the control group(P<0.05).Conclusion Compared with LACR,NOSES has less effect on postoperative oxidative stress and immune system of patients and is more conducive to postoperative recovery.