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目的探讨腹腔镜结直肠癌标本经自然腔道取出手术(natural orifice specimen extraction,NOSE)的近期效果及对患者细胞免疫功能的影响。方法收集湖北省肿瘤医院2014年9月至2016年3月期间接受腹腔镜结直肠癌根治手术的89例患者的临床病理资料,其中标本经肛门取出的腹腔镜结直肠癌根治术患者31例(NOSE组),传统腹腔镜辅助结直肠癌根治术患者58例(LAP组),比较两组患者手术的近期效果及细胞免疫功能指标变化。结果两组患者术前的各临床指标及细胞免疫功能指标相似,差异均无统计学意义(均P>0.05)。患者手术时间、手术并发症发生率及淋巴结检出数目两组差异均无统计学意义(均P>0.05)。NOSE组术后疼痛评分(2.8±0.9分)显著少于LAP组(3.7±1.2分),(t=3.766,P<0.001)。NOSE组和LAP组患者术后排气时间分别为2.6±0.8 d和3.3±0.8 d,(t=4.427,P<0.001)。NOSE组患者术后住院时间较LAP组短,两组分别为7.8±4.3 d和10.3±5.4 d,(t=2.213,P=0.030)。NOSE组与LAP组患者术后第3天CD4+T细胞与术前相比均有显著下降(均P<0.05),且LAP组术后第3天CD4+T细胞比例更低,两组差异有统计学意义(t=4.017,P=0.002)。术后第3天CD8+T细胞及CD4+/CD8+与术前相比,LAP组下降明显,差异有统计学意义(均P<0.05),而NOSE组下降不明显(均P>0.05)。两组患者术后CRP水平均显著升高(均P<0.05),且LAP组升高更加明显,两组术后第3天、第6天CRP水平差异均有统计学意义,均P<0.05。结论结直肠癌NOSE术与传统腹腔镜辅助手术相比,具有更加优越的微创效果,对患者细胞免疫功能影响更小。
Objective To investigate the short-term effect of natural orifice specimen extraction (NOSE) and its effect on cellular immunity in patients with laparoscopic colorectal cancer. Methods The clinical data of 89 patients undergoing laparoscopic radical resection of colorectal cancer from September 2014 to March 2016 in Cancer Hospital of Hubei Province were collected. Among them, 31 patients underwent laparoscopic radical resection of colorectal cancer by anus NOSE group). Fifty-eight patients (LAP group) with conventional laparoscopic-assisted radical resection of colorectal cancer were enrolled in this study. The short-term effects and the changes of cellular immune function were compared between the two groups. Results The preoperative clinical indexes and cellular immune function indexes of two groups were similar, with no significant difference (all P> 0.05). There was no significant difference between the two groups in the time of surgery, the incidence of complications and the number of lymph nodes detected (all P> 0.05). Postoperative pain scores (2.8 ± 0.9) in the NOSE group were significantly less than those in the LAP group (3.7 ± 1.2) (t = 3.766, P <0.001). The postoperative exhaust time in NOSE group and LAP group was 2.6 ± 0.8 d and 3.3 ± 0.8 d, respectively (t = 4.427, P <0.001). The postoperative hospital stay in NOSE group was shorter than that in LAP group, 7.8 ± 4.3 days and 10.3 ± 5.4 days in the two groups (t = 2.213, P = 0.030). The number of CD4 + T cells in the NOSE group and the LAP group decreased significantly (all P <0.05) on the 3rd day after operation, and the proportion of CD4 + T cells in the LAP group was lower on the 3rd day after operation Statistically significant (t = 4.017, P = 0.002). The levels of CD8 + T cells and CD4 + / CD8 + on day 3 postoperatively were significantly lower in LAP group than those in preoperative group (all P <0.05), but not in NOSE group (all P> 0.05). The levels of CRP in both groups were significantly increased (all P <0.05), and the levels of CRP in LAP group were more obvious. There were significant differences in CRP levels between the two groups on the 3rd and 6th day after operation . Conclusion NOSE surgery for colorectal cancer has more superior minimally invasive effect compared with traditional laparoscopic assisted surgery and has less impact on cellular immune function.