腹腔镜经尾侧-中间联合入路治疗右半结肠癌的疗效分析

Efficacy of LaparoscopicCaudal-intermediate Combined Approach in the Treatment of Right Colon Cancer

目的比较腹腔镜经中间入路、尾侧-中间联合入路治疗右半结肠癌的疗效,以及对胃肠激素、免疫指标、人衰老关键蛋白1(FBLN1)、糖类抗原199(CA199)、钙结合蛋白S100A9(S100A9)的影响。方法将2018年1月至2021年5月成都市第三人民医院右半结肠癌患者109例作为研究对象,根据手术入路方式不同分为两组,对照组55例,经中间入路开展腹腔镜治疗,试验组54例,经尾侧-中间联合入路开展腹腔镜治疗,比较两组围手术期各项指标及术后14 d的免疫功能、胃肠激素、肿瘤相关因子和术后并发症。结果两组术中出血量、术后并发症发生率、手术时长、淋巴结清扫数差异无统计学意义(P>0.05)。试验组首次排气时间短于对照组(P<0.05),术后14 d的调节性T细胞(Tregs)、辅助性T细胞Th17、Th2、S100A9、CA199低于对照组(P<0.05),术后14 d的FBLN1、Th1高于对照组(P<0.05)。同时试验组术后1、14 d的抑胃肽、胃动素、胃泌素高于对照组(P<0.05)。结论经尾侧-中间联合入路对右半结肠癌患者进行腹腔镜治疗,能够减轻手术对免疫功能和胃肠道功能的影响,促进术后肠功能恢复,改善肿瘤相关因子。

Objective To compare the efficacy of laparoscopic medial approach and combined caudal-intermediate approach in the treatment of right colon cancer and their influence on gastrointestinal hormones,immune indicators,human aging key protein 1(FBLN1),carbohydrate antigen 199(CA199),and calcium binding protein S100A9(S100A9).Methods A total of 109 patients with right colon cancer in the Third People′s Hospital of Chengdu from January 2018 to May 2021 were selected as the research objects.According to different approaches of laparoscopic-assisted right hemicolectomy,the patients were divided into two groups:control group(intermediate approach,n=55)and experimental group(combined caudal-intermediate approach,n=54).Perioperative indexes,postoperative complications and immune function,gastrointestinal hormones,and tumor-related factors 14 d after operation were compared between the two groups.Results There were no significant differences in intraoperative blood loss,incidence of postoperative complications,duration of operation,and number of lymph node dissected(P>0.05).The first exhaust time in the experimental group was shorter than that in the control group(P<0.05).On the 14th day after operation,regulatory T cells(Tregs),helper T cells Th17 and Th2,S100A9 and CA199 in the experimental group were lower than those in the control group(P<0.05);FBLN1 and Th1 in the experimental group were higher than those in the control group(P<0.05).At the same time,gastric inhibitory peptide(GIP),motilin(MTL)and gastrin(GAS)on the 1st and 14th day after operation in in the experimental group were higher than those in the control group(P<0.05).Conclusion Laparoscopic-assisted right hemicolectomy with combined caudal-intermediate approach can reduce the impact on immune function and gastrointestinal function,promote the recovery of postoperative intestinal function,and improve tumor-related factors.