中间入路与侧方入路腹腔镜根治术治疗右半结肠癌的效果及对免疫功能和应激反应影响的对比分析  

Comparative Analysis of Effect of Laparoscopic Radical Resection Through Middle Approach and Lateral Approach on Right Colon Cancer and Its Influence on Immune Function and Stress Respons

作　　者：曹泽嘉 王世超[1] 张建坡[1] CAO Ze-jia;WANG Shi-chao;ZHANG Jian-po(Department of General Surgery,Zhengzhou Third People's Hospital,Zhengzhou,Henan 450000)

机构地区：[1]郑州市第三人民医院普外科,河南郑州450000

出　　处：《中国肛肠病杂志》2024年第2期12-14,共3页Chinese Journal of Coloproctology

基　　金：河南省医学科技攻关项目(LHGJ2021002165)。

摘　　要：目的:比较中间入路与侧方入路腹腔镜根治术治疗右半结肠癌的效果及对免疫功能、应激反应的影响。方法:以2018年7月至2022年12月我科收治的58例右半结肠癌患者为研究对象,随机分为2组,各29例,2组分别以中间入路(观察组)和侧方入路(对照组)进行手术,比较2组手术效果、术后免疫功能指标CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平及应激反应指标血清肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)水平。结果:观察组淋巴结清除数略多于对照组,但差异无统计学意义,P>0.05;2组手术切除标本长度和术后并发症发生率比较差异无统计学意义,P>0.05;观察组术中出血量少于对照组,手术时间、术后首次排气时间和排便时间短于对照组,P<0.05。观察组术后CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组,P<0.05。观察组术后E、NE、Cor水平均低于对照组,P<0.05。结论:中间入路与侧方入路腹腔镜根治术治疗右半结肠癌均安全有效,但中间入路手术术中出血更少,术后患者恢复更快,对免疫功能及应激反应影响更小。Objective To compare the effect of laparoscopic radical resection through middle approach and lateral approach on right colon cancer and its influence on immune function and stress response.Methods A total of 58patients with right colon cancer admitted to our department from July 2018to December 2022were randomly divided into two groups,with 29cases in each group.Both groups were operated through middle approach(the observation group)and lateral approach(the control group),respectively.The surgical effect,postoperative immune function index levels of CD4^(+),CD8^(+),CD4^(+)/CD8^(+)and stress response index levels of serum epinephrine(E),norepinephrine(NE),cortisol(Cor)levels of the two groups were compared.Results The number of lymph node clearance in the observation group was slightly more than that in the control group,but the difference was not statistically significant(P>0.05).There were no significant differences in the length of surgical specimens and the incidence of postoperative complications between the two groups(P>0.05).The intraoperative blood loss in the observation group was less than that in the control group,and the operation time,the first postoperative exhaust time and defecation time were shorter than those in the control group(P<0.05).Levels of CD4^(+)and CD4^(+)/CD8^(+)in the observation group were higher than those in the control group,and CD8^(+)level in the observation group was lower than that in the control group(P<0.05).The levels of E,NE and Cor in the observation group were lower than those in the control group(P<0.05).Conclusion Both the middle approach and the lateral approach are safe and effective in the treatment of right colon cancer,but the middle approach has less intraoperative bleeding,faster postoperative recovery,and less influence on immune function and stress response.

关 键 词：右半结肠癌 腹腔镜根治术 中间入路 侧方入路 免疫功能 应激反应 

分 类 号：R735.35[医药卫生—肿瘤]