腹腔镜手术与开腹手术对结肠癌患者术后炎性反应和应激反应的影响

Effects of Laparoscopic and Open Surgery on Inflammatory Response and Stress Response in Patients with Colon Cancer after Operation

目的 探讨腹腔镜手术与开腹手术对结肠癌患者术后炎性反应和应激反应的影响。方法 入选本组研究的90例结肠癌患者均来自我院,病例资料选取时间从2018年9月至2019年2月,将所有研究对象按照随机信封法分成两组。对照组45例采取开腹手术治疗,研究组45例采取腹腔镜手术治疗,观察术后并发症,比较两种手术对术后炎性反应和应激反应的影响,分析手术的疗效和安全性。结果 研究组患者术后的白细胞介素-6(IL-6)、单核细胞趋化因子-1(MCP-1)以及白细胞介素-8(IL-8)血清炎性因子均明显低于对照组(P<0.05)。研究组患者术后的去甲肾上腺素(NE)、肾上腺素(E)以及皮质醇(Cor)应激反应指标水平均显著低于对照组(P<0.05)。两组的手术时间、淋巴结清扫个数比较差异无统计学意义(P>0.05),研究组术中出血量(108.22±45.22)mL少于对照组(186.33±51.03)mL(t=7.685,P<0.05)。研究组的术后住院时间、胃肠功能恢复时间与肺部感染发生率低于对照组(P<0.05),但两组切口感染、术后出血、吻合口瘘发生率对比差异无统计学意义(P>0.05)。研究组术后肠梗阻发生率(11.11%)低于对照组(28.89%),差异有统计学意义(χ^(2)=4.444,P<0.05),但两组局部复发、切口种植与远处转移发生率对比差异无统计学意义(P>0.05)。结论 与开腹手术相比较,腹腔镜手术治疗结肠癌患者能更好改善炎性指标,降低应激反应,减轻手术创伤,应用更为安全高效。

Objective To investigate the effects of laparoscopic and open surgery on inflammatory response and stress response in patients with colon cancer after operation. Methods Ninety patients with colon cancer were selected from our hospital. The data were collected from September 2018 to February 2019. All the subjects were divided into two groups according to random envelope method. 45 cases in the control group were treated by open surgery, 45 cases in the study group were treated by laparoscopic surgery. The complications were observed. The effects of the two operations on inflammatory response and stress response were compared, and the efficacy and safety of the operation were analyzed.Results The serum levels of IL-6, MCP-1 and IL-8 in the study group were significantly lower than those in the control group(P<0.05). The levels of norepinephrine(NE), epinephrine(E) and cortisol(Cor) in the study group were significantly lower than those in the control group(P<0.05). There was no difference in operation time and number of lymph node dissection between the two groups(P>0.05). The amount of intraoperative bleeding in the study group(108.22±45.22) mL was less than that in the control group(186.33±51.03) mL(t=7.685, P<0.05).Postoperative hospitalization time, gastrointestinal function recovery time and the incidence of pulmonary infection in the study group were lower than those in the control group(P<0.05). There was no significant difference in the incidence of incision infection, postoperative bleeding and anastomotic leakage between the groups(P>0.05). The incidence of postoperative intestinal obstruction in the study group(11.11%) was lower than that in the control group(28.89%), with a statistically significant difference(χ^(2)=4.444, P<0.05). There was no difference in the incidence of local recurrence, incision implantation and distant metastasis between the two groups(P>0.05). Conclusion Compared with laparotomy, laparoscopic surgery for colon cancer patients can better improve inflammatory indicators, reduce stress response, reduce surgical trauma, reduce lung infection during operation and intestinal obstruction after operation, which is safer and more effective.