摘要
目的探究结肠镜联合腹腔镜治疗结直肠癌效果及对辅助性T细胞Th1/Th2漂移、应激反应的影响。方法选取2016年10月至2018年10月期间广州中医药大学金沙洲医院收治的82例结直肠癌患者为研究对象,依据治疗术式不同分为观察组(n=41)、对照组(n=41)。对照组予以开腹结直肠癌根治术,观察组在结肠镜联合腹腔镜下实施结直肠癌根治术。对比两组手术相关指标、术后并发症发生情况及术前、术后1 d、术后3 d的血清应激指标[皮质醇(COR)、肾上腺素(E)、去甲肾上腺素(NE)]、血清Th1、Th2、Th1/Th2及Th1/Th2有关细胞因子[白细胞介素-10 (IL-10)、白细胞介素-6 (IL-6)、干扰素-γ(IFN-γ)]水平。结果两组淋巴结清扫数目、手术时间对比,差异均无统计学意义(均P> 0.05);观察组住院时间、首次肛门排气时间较对照组短,术中出血量较对照组少,差异均有统计学意义(均P <0.05);观察组术后并发症发生率为7.32%,低于对照组的24.39%,差异有统计学意义(P <0.05);两组术后1 d、3 d血清COR、E、NE水平均较术前增高,但观察组低于对照组,差异均有统计学意义(均P <0.05);两组术后1 d、3 d血清Th1、Th1/Th2水平较术前降低,但观察组高于对照组,血清Th2水平较术前增高,但观察组低于对照组,差异均有统计学意义(均P <0.05);两组术后1 d、3 d血清IL-10、IL-6水平较术前增高,但观察组低于对照组,血清IFN-γ水平较术前降低,但观察组高于对照组,差异均有统计学意义(均P <0.05)。结论对结直肠癌患者采取结肠镜联合腹腔镜治疗可减轻手术创伤,加速术后恢复,降低并发症发生风险,且机体应激反应轻,对免疫功能影响小。
Objectives To investigate the clinical effect of combined laparoscopic-colonoscopic approach in the treatment of colorectal cancer and its effect on T helper 1(Th1)/T helper 2(Th2) balance and stress response. Methods Eighty-two patients with colorectal cancer treated in Jinshazhou Hospital of Guangzhou University of Chinese Medicine between October 2016 and October 2018 were divided into treatment group(n = 41) and control group(n= 41) depending on the types of surgery. Patients in the control group received open surgery, while patients in the treatment group received combined laparoscopic-colonoscopicsurgery. The followings were compared between the two groups: surgical outcomes, postoperative complications, serum indicators of stress(COR, E, and NE), serum levels of Th1 and Th2, Th1/Th2, and related cytokines(IL-10, IL-6, IFN-γ) before surgery,and at day 1 and day 3 after surgery. Results There was no significant difference between the two groups in lymph node yield and duration of surgery(P > 0.05). Patients in the treatment group had significantly shorter duration of hospitalization and time to first bowel movement, as well as fewer intraoperative blood loss than those in the control group(P < 0.05). Incidence of complications was 7.32% in the treatment group, which was significantly lower than that in the control group(24.39%, P < 0.05).The followings were significantly higher at day 1 and 3 after surgery than before surgery in both groups: serum levels of COR,E, NE, Th2, Il-10 and IL-6, which were all significantly lower in the treatment group than in the control group(P < 0.05).The followings were significantly lower at day 1 and day 3 after surgery than before surgery: serum levels of Th1 and IFN-γ,and Th1/Th2, these were all significantly higher in the treatment group than in the control group(P < 0.05). Conclusion Combined laparoscopic-colonoscopic approach for colorectal cancer could minimize surgical wound, promote postoperative recovery, lower the risk of complication. It is also associated with less stress response and less influence on the immune function.
作者
王木勇
Wang Muyong(Department of General Surgery, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510080, Guang? dong, China)
出处
《结直肠肛门外科》
2019年第4期452-457,共6页
Journal of Colorectal & Anal Surgery
