不同入路腹腔镜根治术治疗右半结肠癌患者的效果及其对机体应激反应和免疫功能的影响

Effect of Different Approaches of Laparoscopic Radical Resection in the Treatment of Patients with Right Colon Cancer and Its Influence on the Body’s Stress Response and Immune Function

目的:探究不同入路腹腔镜根治术治疗右半结肠癌患者的效果及其对机体应激反应和免疫功能的影响。方法:选取福建中医药大学附属龙岩人民医院2019年1月-2021年1月70例行腹腔镜肿瘤根治术的右半结肠癌患者。根据随机抽样法将其分为研究组与对照组,各35例。研究组给予侧方入路腹腔镜根治术,对照组给予中间入路腹腔镜根治术。比较两组围手术期指标,术前、术后1 d应激因子[促肾上腺皮质激素(ACTH)、皮质醇(Cor)及醛固酮(ALD)],术前、术后3 d免疫功能。结果:两组淋巴结清扫数目比较差异无统计学意义(P>0.05),研究组术中出血量少于对照组,手术耗时短于对照组,术后排气时间早于对照组(P<0.05)。研究组术后1 d ACTH、Cor、ALD水平均低于对照组(P<0.05)。术后3 d,两组CD3^(+)、CD4^(+)均有降低,CD8^(+)有所升高。术后3 d,研究组CD3^(+)、CD4^(+)水平均高于对照组,CD8^(+)水平低于对照组(P<0.05)。结论:相较于中间入路腹腔镜根治术,侧方入路腹腔镜根治术治疗右半结肠癌患者,手术耗时短,术中出血量少,机体应激反应小,术后恢复快,对免疫功能影响较小,值得应用。

Objective:To explore effect of different approaches of laparoscopic radical resection in the treatment of patients with right colon cancer and its influence on the body’s stress response and immune function.Method:Seventy patients with right colon cancer who underwent laparoscopic radical tumor resection in Longyan People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2019 to January 2021 were selected.According to random sampling method,they were divided into study group and control group,35 cases in each group.The study group was given the lateral approach laparoscopic radical resection,and the control group was given the intermediate approach laparoscopic radical resection.The perioperative indexes,stress factors[adrenocorticotropic hormone(ACTH),cortisol(Cor)and aldosterone(ALD)]before and 1 d after surgery,and immune function before and 3 d after surgery of the two groups were compared.Result:There was no significant difference in the number of lymph node dissection between the two groups(P>0.05).The intraoperative blood loss in the study group was less than that in the control group,the surgery time was shorter than that in the control group,and the postoperative exhaust time was earlier than that in the control group(P<0.05).The levels of ACTH,Cor and ALD in the study group were lower than those in the control group 1 d after surgery(P<0.05).3 d after surgery,CD3^(+)and CD4^(+)decreased in both groups,while CD8^(+)increased.3 d after surgery,the levels of CD3^(+)and CD4^(+)in the study group were higher than those in the control group,while CD8^(+)was lower than that in the control group(P<0.05).Conclusion:Compared with intermediate approach laparoscopic radical resection,lateral approach laparoscopic radical resection in the treatment of right colon cancer patients has shorter surgery time,less intraoperative blood loss,small stress response,fast postoperative recovery,and less impact on immune function,which is worthy of application.