结直肠癌NOSE术的近期效果及对机体细胞免疫功能影响的研究

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。

Effect of laparoscopic resection with natural orifice specimen extraction on short-term outcomes and cellular immunity for colorectal cancer

ObjectiveThis study aimed to evaluate the effect of laparoscopic resection with natural orifice specimen extraction (NOSE) on short-term outcomes and cellular immunity for colorectal cancer. MethodsFrom September 2014 to March 2016, data of 89 colorectal cancer patients who underwent laparoscopic resection were reviewed. All included thirty-one patients underwent laparoscopic resection with NOSE (NOSE group), and fifty-eight patients underwent traditional laparoscopic-assisted resection (LAP group). Short-term outcomes and cellular immunity of the patients in the two groups were compared. ResultsThe baseline characteristics of the two groups were similar (P>0.05). The two groups did not differ in operating time, perioperative complications and the number of lymph node harvest (P>0.05). Pain score after operation in the NOSE group (2.8±0.9) was significantly lower than those in the LAP group (3.7±1.2) (t=3.766, P<0.001). Times to first flatus were 2.6±0.8 days and 3.3±0.8 days in NOSE group and LAP group, respectively (t=4.427, P<0.001). Postoperative hospital stay in NOSE group were 7.8±4.3 days and 10.3±5.4 days in LAP group, (t=2.213, P=0.030). CD4⁺ T cell counts on the 3rd day after operation were significantly lower than those on the day before operation in both groups,and there were significant differences in CD4⁺ T cell counts on the 3rd day after operation between two groups (t=4.017, P=0.002). CD8⁺ T cell counts and CD4⁺ /CD8⁺ were significantly lower than those on the day before operation in LAP group(P<0.05) but not in NOSE group (P>0.05). CRP level was significantly higher after surgery in both group(P<0.05), and CRP level in the LAP group was significantly higher than that of the NOSE group on the 3rd and the 6th day after surgery (P<0.05). ConclusionCompared with traditional laparoscopic-assisted resection, NOSE has better effect of minimally invasive and smaller effect on cellular immunity for colorectal cancer.