摘要
目的探讨腹腔镜与开腹结直肠癌手术对患者炎性反应及免疫功能的影响。方法收集2015年1月1日-2016年7月31日某院普通外科收治的239例结直肠癌患者临床资料,所有患者均接受了手术切除,其中行腹腔镜结直肠癌手术(腹腔镜组)131例,开腹结直肠癌手术(开腹组)108例。比较两组手术情况,术前术后TNF-α、CRP、IL-6水平、T淋巴细胞比例变化差异。结果腹腔镜组术中出血更少、术后恢复更快,但手术时间更长,P<0.05,差异有统计学意义。炎性因子方面,两组患者术前TNF-α、CRP、IL-6均在正常范围内,术后水平明显高于术前,于术后第1天达到峰值,同期相比腹腔镜组低于开腹组P<0.05,差异有统计学意义。术后CD3+、CD4+T淋巴细胞以及CD4+/CD8+比值术后1天均明显降低,于术后3天开始逐渐回升,CD4+/CD8+比值于术后7天基本恢复至术前水平。同期相比,微创组均高于开腹组,P<0.05,差异有统计学意义。结论与开腹手术相比,腹腔镜手术具有术中出血少、术后恢复快等优点,且腹腔镜手术对患者产生的炎性因子释放少、免疫损伤小、免疫抑制程度较轻,有利于患者术后的恢复。
Objective To investigate the effects of laparoscopic surgery and open surgery on inflammatory response and immune function in patients with colorectal cancer. Method From January 2015 to July 2016, 239 patients undergone laparoscopic or open surgeryfor colorectal cancer in the department of general surgery of a hospital. 131 patients of them underwent laparoscopic surgery（laparoscopic group） and 108 patients underwent open surgery（open group）.The levels of TNF-α, CRP, IL-6, lymphocyte count in the two groups were compared and analyzed preoperatively and at 1, 3 and 7 days after the operation. Results Compared with the open group, the laparoscopic group had less blood loss, shorter time to bowel function recovery, longer operative time（P〈0.05）.With regard to inflammatory cytokines, The levels of TNF-α,CRP, IL-6 were within the normal range and significantly increased after surgery（P〈0.05）.These inflammatory cytokinespeaked on postoperative day1. The levels of TNF-α,CRP, and IL-6 in the laparoscopic group were lower than those in the open group at the same postoperativetime point（P〈0.05）. The CD3＋T cell, CD4＋T cell, and CD4＋/CD8＋T cell ratio in the two groups were significantly lower than those before surgery（P〈0.05）.CD4＋/CD8＋T cell ratio increased on postoperative day3 and day 7. The CD3＋T cell, CD4＋T cell, and CD4＋/CD8＋T cell ratio in the laparoscopic group were higher than those in the open group at the same postoperativetime point（P〈0.05）. Conclusion Compared with open surgery, laparoscopic surgery has advantages including less bleeding and shorter time to bowel function recovery.Moreover, the level of inflammatory cytokines and the degree of immune injury and cellular immunosuppression are less than that of open surgery.And laparoscopic surgery is beneficial to postoperative recovery.
作者
胡子龙
吴有军
胡时栋
何长征
张凯
王玉锋
杜晓辉
Hu Zilong;Wu Youjun;Hu Shidong;He Changzheng;Zhang Kai;Wang Yufeng;Du Xiaohui(General surgery, Chinese PLA General Hospital, Beijing 100853, China)
出处
《中国病案》
2018年第4期82-85,共4页
Chinese Medical Record
基金
国家自然科学基金(61471397)
关键词
腹腔镜
结直肠癌
炎性因子
免疫功能
Laparoscopy
Colorectal cancer
Inflammatory cytokines
Immunity
