小切口与腹腔镜辅助右半结肠切除术对结肠癌患者免疫功能影响的比较  

Effect comparison of minilaparotomy and laparoscopic-assisted right hemicolectomy on immune function of patients with colon cancer

作　　者：刘作良[1] 周彤[1] 张广军[1] Liu Zuoliang Zhou Tong Zhang Guangjun(Department of Gastrointestinal Surgery, Institute of Hepatobiliary, Pancreas and Intestinal Diseases, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Chin)

机构地区：[1]川北医学院附属医院胃肠外二科肝胆胰肠疾病研究所,四川南充637000

出　　处：《肿瘤研究与临床》2017年第8期528-531,535,共5页Cancer Research and Clinic

摘　　要：目的 比较小切口与腹腔镜辅助右半结肠切除术对结肠癌患者免疫功能的影响.方法 回顾性分析2009年1月至2014年8月间因结肠癌行右半结肠切除术患者的临床资料,按手术方式分为小切口组与腹腔镜组,分析两组临床及病理资料,比较患者术前1天及术后第1、5天外周血中CD3、CD4、CD8、CD19及自然杀伤（NK）细胞水平的变化.满足正态分布的计量资料比较用t检验或Q检验,计数资料的比较用χ^2检验或Fisher确切概率法.结果 共有408例结肠癌患者行右半结肠切除术,其中26例患者被剔除,其余382例被纳入研究,分为小切口组182例和腹腔镜组200例.两组患者的年龄、性别、体质量指数、TNM分期、肿瘤位置、组织学类型、术中失血量、肛门排气时间、住院时间及术后并发症之间比较,差异均无统计学意义（均P〉0.05）.小切口组手术时间为（131.53±22.57）min,较腹腔镜组的（167.53±22.04）min短,差异有统计学意义（t=15.76,P=0.00）.两组患者术后第1、5天的CD3、CD4、CD8、CD19、NK细胞水平与术前进行组内比较,差异均有统计学意义（均P〈0.05）;两组间比较差异均无统计学意义（均P〉0.05）.结论 小切口与腹腔镜辅助右半结肠切除术对患者机体细胞免疫功能的影响相似.Objective To explore the cell-mediated immune function in patients with colon cancer undergoing minilaparotomy or laparoscopic assisted right hemicolectomy. Methods From January 2009 to August 2014, the colon cancer patients receiving right hemicolectomy were retrospectively analyzed. According to the operation mode, the patients were divided into minilaparotomy group and laparoscopic-assisted group. The clinical and pathological data was analyzed. Cell counts of total CD3, CD4, CD8, CD19 as well as NK cells in venous blood samples were compared between 1 day before surgery and postoperative days （POD） 1 and 5. Measurement data with normal distribution was compared using the t test or Q test. Count data was analyzed usingχ^2 test or Fisher exact probability. Results There were 408 patients with colon cancer undergoing right hemicolectomy, 26 patients of whom were excluded. The remaining 382 patients were recruited in the research, which were divided into minilaparotomy group （182 cases） and laparoscopic-assisted group （200 cases）. There was no significant difference in the age, gender, body mass index, TNM staging, histological type, blood loss, return of bowel function, tumor location, hospital stay and postoperative complications between the two groups （all P〉0.05）. The operating time in minilaparotomy group [（131.53 ± 22.57） min] was shorter than that in laparoscopic-assisted group [（167.53 ± 22.04） min], and there was significant difference （t=15.76, P= 0.00）. Compared with prior to surgery, cell numbers of CD3, CD4, CD8, CD19 and NK cells were lower on POD 1 and POD 5 （all P〈0.05）, but there was no difference between minilaparotomy group and laparoscopic-assisted group （all P〉0.05）. Conclusion The minilaparotomy and laparoscopic-assisted right hemicolectomy have same effect on cellular immune function of patients with colon cancer.

关 键 词：结肠肿瘤 小切口 腹腔镜辅助 免疫 细胞 

分 类 号：R735.35[医药卫生—肿瘤]