腹腔镜手术对结直肠癌患者免疫功能及预后的影响

Effect of laparoscopic surgery on immune function and prognosis of colorectal cancer patients

目的探讨腹腔镜手术对结直肠癌患者免疫功能及预后的影响。方法将86例结直肠癌患者依据手术方法的不同分为开腹组(43例)和腹腔镜组(43例),开腹组行开腹结直肠癌根治术,腹腔镜组行腹腔镜结直肠癌根治术。比较两组患者围手术期相关指标、胃肠功能指标、免疫功能指标以及脱落肿瘤细胞阳性率、复发转移率。结果腹腔镜组患者住院时间、首次排气时间、进食恢复时间均明显短于开腹组,术中出血量明显少于开腹组,手术时间明显长于开腹组,差异均有统计学意义(P﹤0.01)。术后1、3天,两组患者血清胃动素、胃泌素水平均逐渐降低,但腹腔镜组患者胃动素、胃泌素水平均高于开腹组,差异均有统计学意义(P﹤0.05)。术后3天,两组患者CD3^(+)、CD4^(+)、自然杀伤(NK)细胞水平均降低,CD8^(+)水平均升高,但腹腔镜组患者CD3^(+)、CD4^(+)、NK细胞水平均高于开腹组,CD8^(+)水平低于开腹组,差异均有统计学意义(P﹤0.05)。腹腔镜组患者远处转移率低于开腹组,差异有统计学意义(P﹤0.05)。结论结直肠癌患者应用腹腔镜结直肠癌根治术治疗,可减少术中出血量,缩短住院时间,同时可减轻对胃肠功能及免疫功能的影响,促进患者胃肠功能恢复,降低远处转移率。

Objective To investigate the effect of laparoscopic surgery on immune function and prognosis of patients with colorectal cancer.Method A total of 86 patients with colorectal cancer were divided into the laparotomy group(43 cases)and the laparoscopy group(43 cases)according to different surgical methods.The laparotomy group received laparotomy radical resection of colorectal cancer,and the laparoscopy group received laparoscopic radical resection of colorectal cancer.Perioperative related indexes,gastrointestinal function indexes,immune function indexes,positive rate of tumor cell shed,recurrence and metastasis rate were compared between the two groups.Result The duration of hospital stay,first exhaust time and feeding recovery time in laparoscopic group were significantly shorter than those in the laparotomy group,the intraoperative blood loss was significantly less than that in the laparotomy group,and the operation time was significantly longer than that in the laparotomy group,the differences were statistically significant(P<0.01).One and three days after surgery,the levels of motilin and gastrin in two groups decreased gradually,but the levels of motilin and gastrin in laparoscopy group were higher than those in laparotomy group,and the differences were statistically significant(P<0.05).Three days after surgery,the levels of CD3^(+),CD4^(+)and natural killer(NK)cells in two groups were decreased,while the levels of CD8^(+)were increased,but the levels of CD3^(+),CD4^(+)and NK cells in laparoscopy group were higher than those in laparotomy group,and the level of CD8^(+)was higher than that in laparotomy group,and the differences were statistically significant(P<0.05).The rate of distant metastasis in laparoscopy group was lower than that in laparotomy group,and the difference was statistically significant(P<0.05).Conclusion Laparoscopic radical resection of colorectal cancer can reduce intraoperative blood loss,shorten hospital stay,reduce the impact on gastrointestinal function and immune function,promote the recovery of gastrointestinal function,and reduce the rate of distant metastasis in patients with colorectal cancer.