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目的:探讨腹腔镜全结肠系膜切除术对结肠癌患者应激反应与免疫功能的影响。方法:选择2013年1月到2016年1月在我院进行诊治的结肠癌患者130例,根据随机信封抽签原则分为观察组与对照组各65例,观察组采用腹腔镜全结肠系膜切除术,对照组采用开腹手术治疗,比较两组患者治疗前后血清IL-6和TNF-α值、CD4+细胞含量的变化情况,术中出血量、术后肠道恢复时间、术后住院时间以及并发症的发生情况。结果:两组患者均顺利完成手术,术中无严重并发症发生,观察组的术中出血量、术后肠道恢复时间与术后住院时间明显少于对照组(P<0.05)。观察组术后14 d的乳糜漏、伤口感染、肺部感染等并发症发生率为1.5%,明显低于对照组的12.3%(P<0.05)。观察组与对照组术后14 d的CD4+细胞含量分别为36.34±7.83%和33.66±9.82%,都明显高于术前的30.33±6.49%和30.49±5.33%(P<0.05),且观察组明显高于对照组(P<0.05)。观察组与对照组术后14 d的血清白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)值都明显低于治疗前(P<0.05),同时术后14 d观察组的血清IL-6和TNF-α值明显低于对照组(P<0.05)。结论:腹腔镜全结肠系膜切除术能有效提高结肠癌患者的免疫功能,抑制其应激反映,从而促进患者康复,减少术后并发症的发生。
Objective: To investigate the effect of laparoscopic total mesorectal excision on stress response and immune function in patients with colon cancer. Methods: A total of 130 patients with colorectal cancer diagnosed and treated in our hospital from January 2013 to January 2016 were randomly divided into observation group (65 cases) and control group (65 cases) according to the rules of random ensemble. Laparoscopic total mesenteric excision . The control group was treated with laparotomy. The changes of serum IL-6 and TNF-α, CD4 + cell content before and after treatment, blood loss during operation, postoperative intestinal recovery time, postoperative hospital stay and complications Occurrence of the disease. Results: The two groups of patients completed the operation successfully. No severe complications occurred during the operation. The intraoperative blood loss, postoperative intestinal recovery time and postoperative hospital stay in the observation group were significantly less than those in the control group (P <0.05). The incidence of complications such as chylothorax, wound infection and pulmonary infection in observation group was 1.5% at 14 days after operation, which was significantly lower than that in control group (12.3%, P <0.05). The levels of CD4 + cells in the observation group and the control group after 14 days of operation were 36.34 ± 7.83% and 33.66 ± 9.82%, respectively, which were significantly higher than those of the preoperative 30.33 ± 6.49% and 30.49 ± 5.33% (P <0.05) Significantly higher than the control group (P <0.05). The levels of serum IL-6 and TNF-α in observation group and control group at 14 d after operation were significantly lower than those before treatment (P <0.05) and at 14 d after operation The serum IL-6 and TNF-α levels were significantly lower than those of the control group (P <0.05). Conclusion: Laparoscopic total mesocolonectomy can effectively improve the immune function of colon cancer patients, inhibit the stress response, thus promoting patient rehabilitation and reduce the incidence of postoperative complications.