急诊手术与支架联合择期手术治疗梗阻性左半结肠癌对机体急性期反应和免疫功能影响的对比研究  

Comparison of emergency surgery versus expandable stent plus surgery on acute phase response and cellular immune function in patients with complete obstructive left hemicolon cancer

作　　者：胡子龙 魏广辉[1] 渠浩[1] 马华崇[1] 李延森 何长征 李干斌 王振军[1] Hu Zilong;Wei Guanghui;Qu Hao;Ma Huachong;Li Yansen;He Changzheng;Li Ganbin;Wang Zhenjun(Department of General Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院普外科,北京100020

出　　处：《腹部外科》2022年第4期289-293,共5页Journal of Abdominal Surgery

基　　金：国家自然科学基金(82002471)。

摘　　要：目的探讨急诊手术与支架联合择期手术治疗完全梗阻性左半结肠癌对机体急性期反应及细胞免疫功能的影响。方法选取2017年1月至2021年10月首都医科大学附属北京朝阳医院普通外科收治的67例完全梗阻性左半结肠癌病人,收集其临床资料,所有病人均接受了手术治疗,其中行支架置入后择期手术(支架-手术组)31例,急诊手术36例。比较两组围手术期炎性因子指标以及免疫功能如T淋巴细胞比例的变化差异。结果与急诊手术组相比,支架-手术组切口感染并发症发生率更低,差异有统计学意义(P<0.05)。炎性因子方面,两组病人术后水平明显高于术前,差异有统计学意义(P<0.05);术后1 d、3 d相比支架-手术组低于急诊手术组,差异有统计学意义(P<0.05)。CD3^(+)、CD4^(+)T淋巴细胞以及CD4^(+)/CD8^(+)比值术后1 d明显降低,之后逐渐回升;术后3 d相比,支架-手术组高于急诊手术组,差异有统计学意义(P<0.05)。结论与急诊手术相比,支架联合择期手术治疗完全梗阻性左半结肠癌能够降低围手术期并发症发生率,减轻机体围手术期的急性期反应,对病人细胞免疫功能影响更小。Objective To explore the effect of expandable stent plus emergency surgery on acute response and cellular immune function in patients with completely obstructive left hemicolon cancer.Methods From January 2017 to October 2021,clinical data were retrospectively reviewed for 67 surgical patients with completely obstructive left hemicolon cancer.There were elective surgery after stent implantation(n=31)and emergency surgery(n=36).The levels of tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)and lymphocyte count in two groups were compared preoperatively and at 1,3 and 7 days post-operation.Results As compared with emergency surgery group,the complication was lower in stent-surgery group(P<0.05).With regards to inflammatory cytokines,postoperative level of two groups was significantly higher than that pre-operation(P<0.05).The levels of TNF-α,CRP and IL-6 were lower in stent-surgery group than those in emergency surgery group on postoperative day 1 and day 3(P<0.05).Postoperative CD3^(+),CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)ratio declined markedly at Day 1 post-operation and began to rise gradually at Day 3 post-operation.CD3^(+)T cell,CD4^(+)T cell and CD4^(+)/CD8^(+)T cell ratio were higher in stent-surgery group than those in emergency group on postoperative day 3(P<0.05).Conclusion As compared with emergency surgery group,stent-surgery group offers the advantages of lower perioperative complication rate,milder perioperative acute response and less immune dysfunctions.

关 键 词：肠梗阻 左半结肠 肠道支架 免疫功能 

分 类 号：R735.3[医药卫生—肿瘤]