结直肠癌NOSE术对患者氧化应激、免疫功能及机体微炎症的影响  

Effects on Oxidative Stress Reaction,Immune Function and Inflammation during NOSE Radical Surgery for Colorectal Cancer

作　　者：丁海涛[1] 帕尔哈提.阿布都热衣木 韩智君[1] 曹杰[1] 迪米拉[1] DING Hai-tao PAERHATI · Abudureyimu HAN Zhi-jun CAO Jie DiMiLa(Department of General Surgery, Sixth Affiliated Hospital, Xinjiang Medical University, Urumqi 830002, Xinjiang , Chin)

机构地区：[1]新疆医科大学第六附属医院普外科,乌鲁木齐830002

出　　处：《中国现代手术学杂志》2017年第1期9-13,共5页Chinese Journal of Modern Operative Surgery

基　　金：新疆维吾尔自治区自然科学基金资助项目(编号2016D01C217)

摘　　要：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)对结直肠癌患者氧化应激、免疫功能及机体微炎症的影响。方法选取2014年1月~2015年12月我院收治的120例结直肠癌患者,根据随机数字表法将患者分为观察组及对照组,各60例,分别行NOSE结直肠癌根治术和传统腹腔镜结直肠癌根治术治疗。比较两组患者术中出血量、手术时间、术后第1 d VAS评分、术后排气时间及术后住院时间等围手术期指标。于手术前(T1)、术后第3 d(T2)、术后第7d(T3)测定患者氧化应激指标(SOD、MDA)、微炎症因子(CRP、TNF-α、IL-6、IL-10)、免疫功能(NK细胞活性、CD3+、CD4+、CD4+/CD8+、Ig G、Ig M、Ig A)并进行比较。结果观察组术后第1 d VAS评分明显低于对照组,术后排气时间、术后住院时间均短于对照组,差异均有统计学意义(P<0.05),而两组患者术中出血量、手术时间比较均无统计学差异(P>0.05)。两组患者T2、T3时SOD均明显低于T1时,并且T3时SOD明显高于T2时;T2、T3时MAD、CRP、TNF-α、IL-6均明显高于T1时,IL-10明显低于T1时,且T3时MDA、CRP、TNF-α、IL-6均明显低于T2时,IL-10明显高于T2时(P<0.05)。两组患者T2、T3时CD3+、CD4+、Ig M、Ig A均明显低于T1时,且T3时CD3+、CD4+、Ig M、Ig A含量均明显高于T2时(P<0.05)。两组患者间T1时各项指标比较均无统计学差异(P>0.05);观察组T2、T3时SOD、IL-10、CD3+、CD4+、Ig M均明显高于对照组,MAD、CRP、TNF-α、IL-6均明显低于对照组(P<0.05)。结论相对于传统腹腔镜结直肠癌根治术,NOSE结直肠癌根治术可有效减轻氧化应激反应,减少微炎症因子的释放,对机体免疫功能的影响更小。Objective To explore the effect of oxidative stress reaction, immune function and inflammation during the natural orifice specimen extraction （NOSE） radical surgery for the patients with colorectal cancer. Methods A total of 120 colorectal cancer cases from January 2014 to December 2015 in our hospital were divided into observation group and control group according to random digits table, with 60 cases for each. NOSE surgery was performed in the observation group, and conventional laparoscopic radical resection of colorectal cancer was carried out in the control group. The peri-operative index of intra-operative blood loss, operation time, VAS score of 1 st day after the surgery, postoperative exhaust time, postoperative hospital stay were compared between two groups. The oxidative stress reaction index （ SOD, MDA ）, inflammatory factors （ CRP,TNF-α, IL-6, IL-10 ） and immune function index （ NK, CD3 ＋ , CD4 ＋ , CD4 ＋/CD8 ＋ , IgG, IgM, IgA） were determined and compared. Results The VAS score of 1- day after the operation was lower, and both the gastrointestinal recovery time and hospital stays were shorter in the observation group than those in the control group, the differences were statistical significance （P 〈 0.05 ）. There was no statistical difference in intra-operative blood loss and operation time between two groups （P 〉 0.05 ）. In both observation and control groups ： The SOD of both T2 and T3 was lower than that of T1, and the SOD of T3 was higher than that of T2 （ P 〈 0.05）. The MAD,CRP,TNF-α and IL-6 were higher and IL-10 was lower at the time point of T2 and 33 than those of T1, and MDA, CRP,TNF-α,IL-6 was lower and IL-10 was higher at T3 than those at T2（P 〈0.05）. The CD3 ＋ , CD4 ＋ , IgM and IgA of both T2 and 33 were lower than those of T1, and the CD3 ＋ , CD4 ＋ , IgM and IgA of T3 were higher than those of T2 （ P 〈 0.05 ）. In group comparison ： There was no statistical difference in all indexes of T1 between two groups （ P 〉 0.

关 键 词：经自然腔道标本取出术 结直肠癌根治术 结直肠肿瘤 氧化应激 免疫功能 炎症反应 

分 类 号：R735.34[医药卫生—肿瘤]