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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3d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。
Objective: To study the short-term effect of laparoscopic total mesocolon resection on elderly patients with colon cancer and the influence of immune system, and provide evidence for the clinical treatment of colon cancer. Methods: One hundred and sixty-six elderly patients with colon cancer who were treated in our hospital from June 2014 to June 2016 were selected as study subjects and divided into two groups according to patients’ willingness to treat. Laparoscopic total mesocolon resection was performed in 57 cases in the treatment group and 79 cases in the control group underwent laparotomy. The operation time, number of lymph node dissection, intraoperative blood loss, anal exhaust time, ambulation time, postoperative hospital stay and postoperative complications were compared between the two groups. The levels of T lymphocyte subsets (CD3 ~ +, CD4 ~ +, CD8 ~ +) and natural killer (NK) cells in peripheral blood were detected by flow cytometry at 1 day before operation, 1 d after operation and 3 days after operation ). The levels of serum C-reactive protein (CRP), soluble interleukin-2 receptor (sIL- 2R), interleukin-6 (IL-6), interleukin-8 (IL-8) levels. Results: Compared with the control group, the bleeding volume, anal exhaust time, ambulation time and postoperative hospital stay in the treatment group decreased significantly. The difference was statistically significant (P <0.05). There was no significant difference between the two groups in the number of lymph node dissection and operation time (P> 0.05). The incidence of complications in the treatment 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 CD3 +, CD4 + and NK cells and the ratio of CD4 ~ + / CD8 + in peripheral blood T lymphocyte subsets in the treated group at 1 day and 3 days after operation were significantly higher than those at 1 day before operation (P <0.05), and the ratio of CD4 ~ + / CD8 ~ + and NK cells at 1 d after operation were lower than those at 3 d after operation (P <0.05) The proportion of CD8 ~ + in peripheral blood increased with preoperative 1 d, but the difference was not statistically significant (P> 0.05), and the proportion of CD8 ~ + on postoperative day 1 was not significantly different from that on postoperative day 3 Difference (P> 0.05). There was no significant difference in the levels of CD3 ~ + and CD4 ~ + in the peripheral blood of patients in the treatment group between the first day and the third day after operation (P> 0.05), the ratio of CD4 ~ + / CD8 ~ + and NK cells Higher than the control group, the difference was statistically significant (P <0.05). Serum levels of CRP, sIL-2R, IL-6 and IL-8 in the treatment group at 1 and 3 days after operation were significantly higher than those at 1 and 3 days after operation, respectively. Serum levels of CRP, sIL-2R and IL (P <0.05). The levels of CRP, sIL-2R, IL-6 and IL-8 in the treatment group at 1 d after operation and 3 d after operation were lower than those in the control Group, the differences were statistically significant (P <0.05). Conclusions: Compared with open surgery, laparoscopic total mesenteric excision has better curative effect in the near future. It has the advantages of small wound, less bleeding, quick recovery after operation, low incidence of postoperative complications and less impact on immune function , Can be applied to the treatment of elderly colon cancer.