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目的探讨腹腔镜与传统开腹乙状结肠癌根治术的临床疗效及安全性。方法选取经病理活检确诊的112例乙状结肠癌患者,采取随机数字表法将患者分为对照组和观察组各56例,对照组采用传统开腹手术治疗,观察组采用腹腔镜手术治疗。手术前及手术后3 d采用预后营养指数(PNI)评价2组患者的营养状态及预后。比较手术前及手术后3 d 2组患者的T细胞亚群、活性氧物质(ROS)及一氧化氮(NO)水平;并比较2组术后排气时间、术后并发症发生率等手术相关指标。结果观察腹腔镜组患者的术中出血量、切口长度、住院时间、术后排气时间均明显优于对照组(P均<0.05);2组手术时间比较差异无统计学意义(P>0.05)。术后3 d,观察组CD3~+细胞、CD4~+细胞、CD8~+细胞、NO水平、ROS强度均明显优于对照组(P均<0.05)。术后3 d,观察组患者的PNI明显高于对照组(P<0.05)。观察组切口感染率、并发症总发生率及复发率均明显低于对照组(P均<0.05)。结论与传统开腹手术相比,腹腔镜乙状结肠癌根治术导致的免疫应激反应明显降低,患者的免疫功能及营养状态均明显改善,患者并发症发生率及术后复发率显著降低。
Objective To investigate the clinical efficacy and safety of laparoscopy and conventional open radical sigmoid colon cancer. Methods A total of 112 patients with sigmoid colon carcinoma diagnosed by pathological biopsy were selected and randomly divided into control group and observation group with 56 cases in each group. The control group was treated by conventional laparotomy and the observation group by laparoscopic surgery. Preoperative and postoperative 3 d prognostic nutritional index (PNI) evaluation of nutritional status and prognosis of two groups of patients. The levels of T lymphocyte subsets, reactive oxygen species (ROS) and nitric oxide (NO) were compared between the two groups before and 3 days after surgery. The postoperative exhaust time and postoperative complication rate were compared between the two groups Related indicators. Results The intraoperative blood loss, incision length, hospitalization time and postoperative exhaust time in the laparoscopic group were significantly better than those in the control group (all P <0.05). There was no significant difference in operative time between the two groups (P> 0.05 ). At 3 days after operation, CD3 ~ + cells, CD4 ~ + cells, CD8 ~ + cells, NO level and ROS intensity in the observation group were significantly better than those in the control group (all P <0.05). At 3 days after operation, PNI in observation group was significantly higher than that in control group (P <0.05). Incision infection rate, total complication rate and recurrence rate in the observation group were significantly lower than those in the control group (all P <0.05). Conclusions Compared with traditional laparotomy, the immune response induced by laparoscopic radical resection of sigmoid colon is significantly reduced. The immune function and nutritional status of patients are significantly improved. The incidence of complications and postoperative recurrence rate are significantly reduced.