| 房 俊,崔小鹏,樊 勇,王 雷,徐骏飞.腹腔镜全结肠系膜切除术治疗老年结肠癌患者的近期疗效评价及对机体免疫力的影响[J].,2017,17(20):3888-3892 |
| 腹腔镜全结肠系膜切除术治疗老年结肠癌患者的近期疗效评价及对机体免疫力的影响 |
| Short-term Clinical Evaluation of Laparoscopic Complete Mesorectal Excision for Elderly Patients with Colon Cancer and Its Effect on Immunity |
| 投稿时间：2017-03-16 修订日期：2017-04-11 |
| DOI：10.13241/j.cnki.pmb.2017.20.020 |
| 中文关键词: 老年 腹腔镜 全结肠系膜切除术 近期疗效 免疫功能 |
| 英文关键词: Elderly Laparoscopic Complete mesorectal excision Short-term clinical evaluation Immunity function |
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| 中文摘要: |
| 摘要 目的：研究腹腔镜全结肠系膜切除术对老年结肠癌患者的近期疗效评价及机体免疫力的影响，为临床治疗结肠癌提供依据。方法：选择2014年6月至2016年6月我院收治的136例老年结肠癌患者为研究对象，按照患者治疗意愿分为两组。治疗组57例行腹腔镜下全结肠系膜切除术，对照组79例行开腹手术。比较两组患者的手术时间、淋巴结清扫数量、术中出血量、肛门排气时间、下床活动时间、术后住院时间及术后并发症发生率。于术前1 d、术后1 d及术后3 d采用流式细胞仪检测两组患者外周血中T淋巴细胞亚群（CD3+、CD4+、CD8+）及自然杀伤（NK）细胞；于术前1 d、术后1 d及术后3 d采用酶联免疫吸附法（ELISA）测定两组患者血清C反应蛋白（CRP）、可溶性白细胞介素-2受体（sIL-2R）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）浓度。结果：与对照组比较，治疗组术中出血量减少，肛门排气时间、下床活动时间及术后住院时间均缩短，差异均有统计学意义（P＜0.05）。两组患者淋巴结清扫数量及手术时间比较，差异无统计学意义（P＞0.05）。治疗组并发症发生率为7.02%，低于对照组的17.72%，差异具有统计学意义（P＜0.05）。治疗组患者术后1 d和术后3 d外周血中T细胞亚群CD3+、CD4+和NK细胞所占比例及CD4+/CD8+的比值与术前1 d相比有所减小（P＜0.05），且术后1 d的CD4+/CD8+的比值和NK细胞低于术后3 d（P＜0.05）；两组术后1 d及术后3 d外周血中CD8+所占比例与术前1 d有所升高，但是差异无统计学意义（P＞0.05），且术后1 d的CD8+所占比例与术后3 d比较无明显差异（P＞0.05）。治疗组患者术后1 d和术后3天外周血中CD3+、CD4+与对照组比较，差异无统计学意义（P＞0.05），CD4+/CD8+的比值和NK细胞高于对照组，差异有统计学意义（P＜0.05）。治疗组术后1 d及术后3 d血清CRP、sIL-2R、IL-6、IL-8水平与均较术前1 d增高，术后3 d治疗组血清中CRP、sIL-2R、IL-6、IL-8水平低于术后1 d（P＜0.05），治疗组术后1 d及术后3 d血清中CRP、sIL-2R、IL-6、IL-8水平均低于对照组，差异均具有统计学意义（P＜0.05）。结论：腹腔镜全结肠系膜切除术与开腹手术相比，近期疗效更好，具有创口小、出血量少、术后恢复快、术后并发症发生率低及对机体免疫功能影响小等优点，可应用于老年结肠癌的治疗。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the short-term clinical effect of laparoscopic complete mesorectal excision for elderly patients with colon cancer and its effect on immunity, in order to provide a clinical basis for the treatment of colon cancer. Methods: 136 cases of elderly patients with colon cancer who were treated in our hospital from June 2014 to June 2016 were enrolled as the subjects. They were divided into two groups according to the patient's treatment intention. 57 cases in the therapy group were treated with laparoscopic complete mesorectal excision, and 79 cases in the control group were treated with open resection. The operation time,number of lymph node dissection, intraoperative blood loss,anal exhaust time, getting out of bed time,postoperative hospital stay and postoperative complications were compared between the two groups. T lymphocyte subsets (CD3+, CD4+, CD8+) and natural killer (NK) cells were detected by flow cytometry at 1d before operation, 1 day and 3 days after operation.The levels of serum C-reactive protein (CRP), soluble interleukin-2 receptor (sIL-2R), interleukin-6 (IL-6) and interleukin-8 (IL-8) were measured by enzyme-linked immunosorbent assay (ELISA) at 1 d before operation, 1 d and 3 d after operation. Results: Compared with the control group, the therapy group had less intraoperative blood loss, the time of anal exhaust, the time of getting out of bed and the time of hospitalization, the difference was statistically significant (P<0.05). There was no significant difference in the number of lymph node dissection and operation time between the two groups (P>0.05). The incidence of complications in the therapy group was 7.02%, which was lower than that in the control group (17.72%), the difference was statistically significant (P<0.05). The ratio of T cell subsets (CD3+, CD4+) and NK cells and the ratio of CD4+/CD8+ in peripheral blood of the two groups in 1 d and 3 d after operation were significantly decreased than those in 1 d before operation (P<0.05), and the ratio of CD4+/CD8+ and NK cells of 1 d after operation were lower than those of 3 d after operation (P<0.05). The proportion of CD8+ in peripheral blood of both groups in 1d and 3d after operation were higher than that of 1 d before operation,but the difference was not statistically significant (P>0.05). And the proportion of CD8+ in 1d after operation had no significant difference when compared with 3 d after operation (P>0.05). There was no significant difference in CD3+ and CD4+ between the two groups in 1d and 3 d after operation (P>0.05). Compared with the control group, the ratio of CD4+/CD8+ and NK cells in therapy group were higher, and the difference was statistically significant (P<0.05). The levels of serum CRP, sIL-2R, IL-6 and IL-8 in the therapy group in 1d and 3d after operation were significantly higher than those in 1 d before operation (P<0.05), and also were lower than those in the control group, the difference was statistically significant (P<0.05). Conclusion: Compare with open surgery, laparoscopic complete mesorectal excision has a better efficacy, with small wound, less bleeding, rapid postoperative recovery, less postoperative complications, lower impact of immune system and other advantages, which can be used in the treatment of elderly colorectal cancer. |
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