腹腔镜微创手术与开腹手术对结直肠癌患者免疫功能、应激反应及疗效的影响

目的对比研究腹腔镜微创手术与开腹手术对结直肠癌患者免疫功能、应激反应及疗效的影响。方法选取2015年5月至2019年5月周口市中医院普外科收治的43例结直肠癌患者作为研究对象,并按照随机数表法将其随机分为研究组(22例)与对照组(21例),其中研究组患者采用腹腔镜微创手术予以治疗,对照组患者采用开腹手术予以治疗,对比观察两组患者的临床疗效以及手术前后CD3^+、CD4^+、CD8^+等免疫功能相关指标水平,白细胞介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)等炎症因子水平与卡氏功能状态(karnofsky performance status,KPS)评分。结果研究组患者手术时间明显长于对照组(t'=4.431,P=0.000),术中出血量明显少于对照组(t'=10.323,P=0.000),肠蠕动恢复时间及住院时间明显短于对照组(t/t'=7.129、6.220,P均=0.000);术后3、7 d,两组患者CD3^+、CD4^+水平均呈先降低后升高的趋势,且研究组患者CD3^+、CD4^+水平均明显高于对照组(3 d:t/t'=2.251、4.795,P=0.031、0.000;7d:t=2.353、3.100,P=0.023、0.003),而CD8^+水平呈先升高后降低的趋势,且研究组患者CD8^+水平明显低于对照组(3d:t=2.068,P=0.045;7 d:t=2.714,P=0.010);术后3、7 d,两组患者IL-6、CRP与TNF-α水平均呈先升高后降低的趋势,且研究组患者IL-6、CRP与TNF-α水平均明显低于对照组(3 d:t/t'=3.430、2.188、3.670,P=0.002、0.034、0.001;7 d:t/t'=2.529、2.971、2.127,P=0.016、0.006、0.041);术后2周,研究组患者KPS评分明显高于对照组(t=3.361,P=0.002)。结论腹腔镜微创手术治疗结直肠癌可有效缩短患者的术后恢复时间,减轻机体应激反应,提高患者免疫功能及生存质量,疗效显著,临床应用价值较高。

Effect of Minimally Invasive Laparoscopic Surgery and Laparotomy on Immune Function and Stress Response of Patients with Colorectal Cancer and the Therapeutic Efficacy

Objective To compare the effect of minimally invasive laparoscopic surgery and laparotomy on the immune function and stress response of patients with colorectal cancer and the therapeutic efficacy.Methods Forty-three patients with colorectal cancer,admitted to the General Surgery of Zhoukou Hospital of Traditional Chinese Medicine from May2015 to May 2019,were selected as study subjects,and then divided,according to random number table,into a study group(22 cases)and a control group(21 cases).Patients in the study group were treated with minimally invasive laparoscopic surgery while patients in the control group were treated with laparotomy.The clinical efficacy,the levels of immune-related indicators such as CD3^+,CD4^+,CD8^+,the levels of inflammatory factors such as interleukin-6(IL-6),c-reactive protein(CRP)and tumor necrosis factor-α(TNF-a)and karnofsky performance status(KPS)of patients in the two groups were compared before and after surgery.Results The surgery time in the study group was significantly longer than that in the control group(t’=4.431,P=0.000);the intraoperative blood loss in the study group was significantly less than that in the control group(t’=10.323,P=0.000);the intestinal peristalsis recovery time and duration of hospitalization in the study group were significantly shorter than those in the control group(t/t’=7.129,6.220,P=0.000,0.000);3 and 7 days after the surgery,the levels of CD3^+and CD4^+in the two groups showed a trend of decrease first followed by increase;their levels in the study group was significantly higher than those in the control group and the comparison showed statistically significant difference(3 d:t/t’=2.251,4.795,P=0.031,0.000;7 d:t=2.353,3.100,P=0.023,0.003);the level of CD8^+showed a trend of increase first followed by decrease.Its level in the study group was significantly lower than that in the control group and the comparison showed statistically significant difference(3 d:t=2.068,P=0.045;7 d:t=2.714,P=0.010);3 and 7 days after the surgery,the levels of IL-6,CRP and TNF-a in the two groups showed a trend of increase first followed by decrease:the levels of IL-6,CRP and TNF-a in the study group were significantly lower than those in the control group and the comparison showed statistically significant difference(3 d:t/t’=3.430,2.188,3.670,P=0.002,0.034,0.001;7 d:t/t’=2.529,2.971,2.127,P=0.016,0.006,0.041);2 weeks after the surgery,KPS score in the study group was significantly higher than that in the control group and the comparison showed statistically significant difference(t=3.361,P=0.002).Conclusion Minimally invasive laparoscopic surgery for colorectal cancer can shorten patients’postoperative recovery time,reduce their systemic stress response,improve their immune function and quality of life,so it has good curative effect and high value of clinical application.