腹腔镜结直肠癌标本经自然腔道取出术与传统腹腔镜结直肠癌根治术对患者术后康复的影响

目的:比较腹腔镜结直肠癌标本经自然腔道取出术（NOSE）与常规腹腔镜结直肠癌根治术（LCR）对患者术后康复的影响。方法:将本院收治的116例结直肠癌患者作为研究对象，随机分为对照组采取常规LCR术，研究组采取腹腔镜结直肠癌标本NOSE术，两组各58例。比较两组患者手术相关指标包括手术时间、术中出血量、术后住院天数和术后排气时间；比较两组患者术前、术后3 d时氧化应激指标、免疫学指标和炎症因子的水平。结果:两组患者手术时间和术中出血量的比较，均无明显差异（均P＞0.05）；但研究组术后住院天数和术后排气时间较对照组明显缩短（均P＜0.05）。两组患者术后3 d时超氧化物歧化酶（SOD）水平较术前均明显降低，且研究组降低幅度较对照组小（均P＜0.05）；两组患者术后3 d时丙二醛（MDA）水平较术前均明显升高，且研究组升高幅度较对照组小（均P＜0.05）。两组患者术后3 d时免疫球蛋白A（IgA）和免疫球蛋白M（IgM）的水平较术前均显著降低，且研究组IgM降低幅度较对照组小（均P＜0.05）；而两组术后3 d时IgA水平的比较，并无明显差异（P＞0.05）。两组患者术后3 d时肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）和白介素-6（IL-6）的水平较术前均显著升高，且研究组升高幅度较对照组小（均P＜0.05）；两组患者术后3 d时白介素-10（IL-10）的水平较术前显著降低，且研究组降低幅度较对照组小（均P＜0.05）。结论:腹腔镜结直肠癌标本NOSE术较常规LCR术能够明显缓解结直肠癌患者氧化应激反应，抑制炎症因子的释放，减少对机体免疫功能的影响，因此具有良好的临床应用价值。

Effect on postoperative rehabilitation of natural orifice specimen extraction for laparoscopic radical surgery and conventional laparoscopic colorectal resection

Objective:To compare the effect of natural orifice specimen extraction(NOSE) for laparoscopic radical surgery and conventional laparoscopic colorectal resection(LCR) on postoperative recovery.Methods:116 cases of colorectal cancer in our hospital were randomly divided into control group receiving conventional LCR surgery,and the study group received NOSE for laparoscopic radical surgery,with 58 cases in each group.The operative indicators,including operative time,intraoperative bleeding loss,postoperative hospitalization days and postoperative exhaust time,were compared between the two groups.The levels of oxidative stress,immunology and inflammatory factors before and 3 days after operation were compared in the two groups.Results:There was no significant difference in operative time and intraoperative bleeding loss between the two groups(both P＞0.05),but the length of hospital stays and postoperative exhaust time in the study group were significantly shorter than those in the control group(both P＜0.05).The superoxide dismutase(SOD) levels of the two groups at 3 days after operation were significantly lower than those before operation,and the decreasing degree in the study group was smaller than that in the control group(all P＜0.05).The levels of malondialdehyde(MDA) in the two groups increased significantly at 3 days after operation,and the increasing degree in the study group was smaller than that in the control group(all P＜0.05).The levels of immunoglobulin A(IgA) and immunoglobulin M(IgM) of the two groups at 3 days after operation were significantly lower than those before operation,and the decreasing degree of IgM in the study group was smaller than that in the control group(all P＜0.05),but there was no significant difference in the IgA level between the two groups at 3 days after operation(P＞0.05).The tumor necrosis factor-α(TNF-α),C-reactive protein(CRP) and interleukin-6(IL-6) levels of the two groups at 3 days after operation were significantly higher than those before operation,and the increasing degree in the study group was smaller than that in the control group(all P＜0.05).The interleukin-10(IL-10) levels of the two groups at 3 days after operation were significantly lower than those before operation,and the decreasing degree of IL-10 was smaller than that in the control group(all P＜0.05).Conclusion:Compared with conventional LCR,NOSE for laparoscopic radical surgery can significantly relieve the oxidative stress reaction,inhibit the release of inflammatory factors and reduce the influence on immune function in patients with colorectal cancer,so it has good clinical application value.