腹腔镜手术对子宫内膜癌患者肿瘤标志物、凝血功能及免疫功能的影响

Effect of laparoscopic surgery on tumor markers,coagulation function and immune function in patients with endometrial cancer

目的探讨腹腔镜手术对子宫内膜癌患者肿瘤标志物、凝血功能及免疫功能的影响。方法根据手术方法的不同将87例子宫内膜癌患者分为开腹组(n=43,开腹手术)和腹腔镜组(n=44,腹腔镜手术)。比较两组患者的围手术期指标、血清肿瘤标志物[糖类抗原125(CA125)、癌胚抗原(CEA)、人附睾蛋白4(HE4)]水平、凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及纤维蛋白原(FIB)]、免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))以及并发症发生情况。结果腹腔镜组患者的手术时间、术后首次排气时间、术后首次下床时间、置管时间、住院时间均明显短于开腹组,术中出血量明显少于开腹组,差异均有统计学意义(P﹤0.01)。术后3天,两组患者血清CA125、HE4、CEA水平均低于本组术前,腹腔镜组患者血清CA125、HE4、CEA水平均低于开腹组,差异均有统计学意义(P﹤0.05)。术后3天,两组患者PT、APTT均短于本组术前,FIB水平均高于本组术前,腹腔镜组患者PT、APTT均短于开腹组,FIB水平高于开腹组,差异均有统计学意义(P﹤0.05)。术后3天,两组患者CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均低于本组术前,CD8^(+)水平均高于本组术前,腹腔镜组患者CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)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)。腹腔镜组患者并发症总发生率低于开腹组(P﹤0.05)。结论腹腔镜手术治疗子宫内膜癌患者可减少术中出血量,缩短手术时间,降低血清肿瘤标志物水平,减轻对免疫功能的影响,促进患者术后恢复,且安全性较高,但易对凝血功能产生不良影响,临床需采取相应措施。

Objective To investigate the effect of laparoscopic surgery on tumor markers,coagulation function and immune function in patients with endometrial cancer.Method A total of 87 patients with endometrial cancer were divided into open group(n=43,open surgery)and laparoscopic group(n=44,laparoscopic surgery)according to different surgical methods.The perioperative indicators,serum tumor markers[carbohydrate antigen 125(CA125),carcinoembryonic antigen(CEA),human epididymis protein 4(HE4)],coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)],immune function indicators(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))and the incidence of complications were compared between the two groups.Result The operation time,first postoperative exhaust time,first postoperative getting out of bed time,catheterization time and hospital stay in laparoscopic group were significantly shorter than those in open group,and the intraoperative blood loss was significantly less than that in open group,and the differences were statistically significant(P<0.01).Three days after surgery,the serum CA125,HE4 and CEA levels in both groups were lower than those before surgery,and the serum CA125,HE4 and CEA levels in laparoscopic group were lower than those in open group,and the differences were statistically significant(P<0.05).Three days after surgery,the PT and APTT in both groups were shorter than those before surgery,and the FIB levels were higher than those before surgery,the PT and APTT in laparoscopic group were shorter than those in open group,and the FIB level was higher than that in open group,and the differences were statistically significant(P<0.05).Three days after surgery,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+) in both groups were lower than those before surgery,and the levels of CD8^(+)were higher than those before surgery,and the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+) in laparoscopic group were higher than those in open group,and the level of CD8^(+) was lower than that in open group,and the differences were statistically significant(P<0.05).The total incidence of complications in laparoscopic group was lower than that in open group(P<0.05).Conclusion In the treatment of patients with endometrial cancer,laparoscopic surgery can reduce the amount of intraoperative blood loss,shorten the operation time,reduce the levels of serum tumor markers and the impact on immune function,promote postoperative recovery,and have high safety,but it is easy to have adverse effects on coagulation function,and corresponding measures should be taken clinically.