冯会和,付召军,白凤琴,魏健,张陈
FENG Huihe,FU Zhaojun,BAI Fengqin,WEI Jian,ZHANG Chen

• 1:自贡市第四人民医院普外一科

摘要(Abstract)：

目的:探讨腹腔镜结直肠全系膜切除术对结直肠癌患者外周血炎症因子和免疫功能的影响。方法:400例结直肠癌患者均分为对照组和研究组,对照组采用传统开腹结直肠全系膜切除术治疗,研究组采用腹腔镜结直肠全系膜切除术治疗,比较两组患者手术时间、术中出血量、术后首次排气时间及首次进食时间、术后住院时间;于术前、术后第1及第7天时采集患者外周血,检测血清肿瘤坏死因子(TNF-ɑ)、C反应蛋白(CRP)、降钙素原(PCT)及白细胞介素-6(IL-6)、免疫球蛋白G (IgG)、IgM及IgA水平,检测外周血CD3+、CD4+、CD8+淋巴细胞亚群百分比及CD4+/CD8+比值;随访5年,比较两组患者并发症及复发、死亡等预后情况。结果:与对照组比较,研究组术后首次排气时间及首次进食时间、术后住院时间均显著缩短,术中出血量显著降低(P<0.05);术后第1及第7天时,两组患者TNF-ɑ、CRP、PCT及IL-6水平较术前显著升高,IgG、IgM、IgA水平较术前显著降低(P<0.05);术后第1及第7天时,研究组TNF-ɑ、CRP、PCT及IL-6水平显著低于同时点对照组,IgG、IgM、IgA水平显著高与同时点对照组(P<0.05);术后第1天,两组患者外周血CD3+、CD4+淋巴细胞百分比及CD4+/CD8+比值较术前显著降低,CD8+淋巴细胞百分比较术前显著升高(P<0.05);术后第7天,研究组CD3+、CD4+、CD8+淋巴细胞百分比及CD4+/CD8+比值恢复至术前水平(P>0.05),对照组与术前比较差异无统计学意义(P<0.05);研究组患者术后感染、术后出血、排尿功能障碍及排便功能障碍等并发症显著低于对照组(P<0.05);2组患者术后随访5年病死率及复发率比较差异无统计学意义(P>0.05)。结论:结直肠癌患者采用腹腔镜结直肠全系膜切除术治疗,具有出血量少、术后并发症少、恢复快等优势,手术对患者炎症因子和免疫功能的影响较小。
Objective:To investigate the effect of laparoscopic total mesorectal excision on inflammatory factors and immune function in peripheral blood of patients with colorectal cancer.Methods:400 patients with colorectal cancer were divided into control group and study group.The control group was treated with traditional open total mesorectal excision.The study group was treated with laparoscopic total mesorectal excision.Surgery time,intraoperative blood loss,first exhaust time,first feeding time and postoperative hospital stay were compared between the two groups.Peripheral blood was collected before operation and on the 1 st and 7 th day after operation to detect tumor necrosis factor(TNF-ɑ),Creactive protein(CRP),procalcitonin(PCT) and interleukin-6(IL-6),immunoglobulin G(IgG),IgM,IgA levels,and the percentage of CD3+,CD4+,CD8+lymphocyte subsets and the ratio of CD4+/CD8+in peripheral blood were measured.Complications and prognosis such as recurrence and death were compared between the two groups.Results:Compared with the control group,first exhaust time,first feeding time and postoperative hospital stay were significantly shorter and the surgical bleeding volume were significantly lower in the study group(P<0.05).The levels of TNF-ɑ,CRP,PCT and IL-6 on the 1 st and 7 th day after operation were significantly higher than those before operation,and IgG,IgM,and IgA levels were significantly lower than those before operation(P<0.05).The levels of TNF-ɑ,CRP,PCT and IL-6 in study group after operation were lower than those in control group,and IgG,IgM,and IgA levels were higher than those in control group(P<0.05).On the first day after operation,the percentage of CD3+,CD4+lymphocyte and CD4+/CD8+ratio in peripheral blood of the two groups were significantly lower than those before operation,and the percentage of CD8+lymphocyte was significantly higher than that before operation(P<0.05).On the 7 th day after operation,the percentage of CD3+,CD4+,CD8+lymphocyte and the ratio of CD4+/CD8+in the study group recovered to the preoperative level(P>0.05).The complications of infection,bleeding,dysfunction of urination and defecation in the study group were significantly lower than those in the control group(P<0.05).There was no significant difference in mortality and recurrence rate between the two groups after 5-year follow-up(P>0.05).Conclusions:Laparoscopic total mesorectal excision for colorectal cancer patients has the advantages of less bleeding,less postoperative complications,faster recovery,less release of inflammatory factors and less influence on immune function.

关键词(KeyWords)： 腹腔镜;结直肠全系膜切除术;结直肠癌;炎症因子;免疫功能;预后
laparoscopic;total mesorectal excision;colorectal cancer;inflammatory factors;immune function;prognosis

Abstract:

Keywords:

基金项目(Foundation): 四川省教育厅自然科学基金(18ZB0505)

作者(Author): 冯会和,付召军,白凤琴,魏健,张陈
FENG Huihe,FU Zhaojun,BAI Fengqin,WEI Jian,ZHANG Chen

DOI: 10.19367/j.cnki.1000-2707.2019.07.024

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