3D腹腔镜下全结肠系膜切除术对右半结肠癌患者 术后MicroRNA-101和CD4+水平变化及 局部复发率的影响

目的探讨3D腹腔镜下全结肠系膜切除术对右半结肠癌患者术后MicroRNA-101、T细胞亚群指标水平变化及局部复发率的影响。方法选取该院2015年3月-2017年4月右半结肠癌患者86例,随机数字表法分为对照组(n=43)与研究组(n=43)。对照组采取传统开腹手术,研究组采取3D腹腔镜下全结肠系膜切除术。统计两组患者围手术期情况、术前及术后1和3 d血清T细胞亚群指标(CD3~+、CD4~+、CD8~+和CD4~+/CD8~+)水平、手术前后MicroRNA-101水平和并发症发生率,随访6～12个月,统计两组局部复发率。结果①围术期情况:研究组淋巴结清扫数目与对照组无显著差异(P0.05),研究组术中失血量少于对照组,手术时间、肛门排气用时、住院时间和开始进食时间短于对照组(P 0.05);②T细胞亚群:术后第1天两组血清CD3~+、CD4~+和CD4~+/CD8~+水平均较术前降低,CD8~+水平较术前增高(P 0.05),术后第3天两组血清CD3~+、CD4~+和CD4~+/CD8~+水平均较术后第1天增高,CD8~+水平较术后第1天降低(P 0.05),且研究组术后各时间段血清CD3~+、CD4~+、CD8~+和CD4~+/CD8~+水平均优于对照组(P 0.05);③MicroRNA-101:术前两组MicroRNA-101水平无显著差异(P0.05),术后两组MicroRNA-101水平较术前增高,且研究组高于对照组(P 0.05);④局部复发率:研究组术后6和9个月局部复发率(0.00%和4.65%)与对照组(6.98%和13.95%)比较,差异无统计学意义(P0.05),研究组术后12个月局部复发率(4.65%)低于对照组(18.60%),差异有统计学意义(P 0.05);⑤并发症:研究组并发症发生率(6.98%)低于对照组(23.26%),差异有统计学意义(P 0.05)。结论 3D腹腔镜下全结肠系膜切除术对右半结肠癌淋巴结清除效果较好,可减少手术创伤,减轻手术对机体免疫功能造成的损伤,提高MicroRNA-101水平,可降低疾病局部复发风险和并发症发生率,安全性高,利于改善预后效果。

Impact of 3D laparoscopic total mesocolic resection on Microrna-101 and CD4+ levels and local recurrence rate in patients with right colon cancer after operation

Abstract: Objective To explore the effect of laparoscopic total mesocolic resection (TME) on microRNA-101, T cell subsets and local recurrence rate in patients with right colon cancer after operation. Methods From March 2015 to April 2017, 86 patients with right colon cancer were randomly divided into control group (n = 43) and research group (n = 43). The control group was treated with traditional laparotomy, while the study group was treated with 3D laparoscopic total mesocolon resection. The perioperative conditions, serum T cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+) levels, microRNA-101 water and the incidence of complications before and after operation were analyzed. The local recurrence rates of the two groups were followed up for 6 to 12 months. Results Perioperative condition: There was no significant difference in the number of lymph node dissection between the study group and the control group (P > 0.05). The blood loss in the study group was less than that in the control group. The operation time, anal exhaust time, hospitalization time and starting eating time in the study group were shorter than that in the control group (P < 0.05). T cell subsets: On the first day after operation, the levels of CD3+, CD4+, CD4+/CD8+ in the two groups were lower than that before operation, and the serum levels of CD3+, CD4+, CD4+/CD8+ increased on the 3rd day after operation, and CD8+ decreased on the 1st day after operation (P < 0.05). The serum levels of CD3+, CD4+, CD8+ and CD4+/CD8+ in the study group were higher than that in the control group (P < 0.05). MicroRNA-101: There was no significant difference in microRNA-101 level between the two groups before operation (P > 0.05). There was no significant difference in microRNA-101 levels between the two groups after operation (P > 0.05). The level of microRNA-101 was higher than that of the control group (P < 0.05). The local recurrence rate: the local recurrence rate of the study group at 6 and 9 months after operation (0.00% and 4.65%) was not significantly different from that of the control group (6.98% and 13.95%) (P > 0.05). The local recurrence rate of the study group at 12 months after operation (4.65%) was lower than that of the control group (P < 0.05). Complications: The incidence of complications in the study group (6.98%) was lower than that in the control group (23.26%) with statistical significance (P < 0.05). Conclusion 3D laparoscopic total mesocolic resection for right colon cancer is effective in lymph node dissection. It can reduce surgical trauma and the injury of immune function caused by surgery, improve the level of microRNA-101, and decrease the risk of local recurrence and the incidence of complications. It is safe and conducive to improving the prognosis.