腹腔镜根治术对结直肠癌患者胃肠功能、免疫功能及炎性反应的影响  

Effects of laparoscopic radical surgery on gastrointestinal function,immune function and inflammatory response in patients with colorectal cancer

作　　者：钱国武[1] 马双阳 牛刚[1] 裴书飞 王新伟[1] 吕柯[1] 宋展[1] QIAN Guowu;MA Shuangyang;NIU Gang;PEI Shufei;WANG Xinwei;LYU Ke;SONG Zhan(Gastrointestinal Ward II,Department of General Surgery/He’nan Province Minimally Invasive Engineering Technology Research Center for Colorectal Tumors/Nanyang City Key Laboratory of Colorectal Cancer Research/Nanyang City Digestive Disease(Colorectal Tumor)Clinical Medical Research Center,Nanyang Central Hospital,Nanyang 473009,He’nan,China;Ward II,Department of Digestive Medicine,Nanyang Central Hospital,Nanyang 473009,He’nan,China)

机构地区：[1]南阳市中心医院普通外科胃肠二病区/河南省结直肠肿瘤微创工程技术研究中心/南阳市大肠癌研究重点实验室/南阳市消化疾病(结直肠肿瘤)临床医学研究中心,河南南阳4730090 [2]南阳市中心医院消化内科二病区,河南南阳4730090

出　　处：《癌症进展》2024年第22期2451-2454,2458,共5页Oncology Progress

基　　金：河南省科技发展计划项目(232102310295);南阳市科技发展计划项目(KJGG099)。

摘　　要：目的探讨腹腔镜根治术对结直肠癌患者胃肠功能、免疫功能及炎性反应的影响。方法依据手术方式的不同将112例结直肠癌患者分为开放组和腔镜组,每组56例,开放组患者接受开放式根治术,腔镜组患者接受腹腔镜根治术。比较两组患者的手术相关指标、胃肠功能指标[表皮生长因子(EGF)、血管活性肠肽(VIP)、P物质、胃动素、胃泌素]、炎性因子指标[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、营养状态指标[血红蛋白(Hb)、视黄醇结合蛋白(RBP)、转铁蛋白(TRF)、前白蛋白(PAB)、白蛋白(ALB)]和免疫功能指标[淋巴细胞计数、中性粒细胞计数、辅助性T细胞(Th)1/Th2、CD4^(+)/CD8^(+)]。结果腔镜组患者手术时间明显长于开放组,术中出血量明显少于开放组,肠鸣音恢复时间、首次排气时间、首次排便时间、首次下床活动时间、住院时间均明显短于开放组,差异均有统计学意义(P﹤0.01)。术后3天,腔镜组患者EGF、P物质、VIP、CRP、PCT、TNF-α、IL-6水平和中性粒细胞计数均低于开放组,胃动素、胃泌素、Hb、RBP、TRF、PAB、ALB水平和淋巴细胞计数、Th1/Th2、CD4^(+)/CD8^(+)均高于开放组,差异均有统计学意义(P﹤0.05)。结论腹腔镜根治术有利于促进结直肠癌患者胃肠功能的恢复,可减轻炎性反应,改善免疫功能和营养状态。Objective To explore the effects of laparoscopic radical surgery on gastrointestinal function,immune function and inflammatory response in patients with colorectal cancer.Method According to the different surgical meth-ods,112 colorectal cancer patients were divided into the open group and the laparoscopic group,with 56 cases in each group.The patients in the open group underwent open radical surgery,while patients in the laparoscopic group underwent laparoscopic radical surgery.The surgery related indexes,gastrointestinal function indexes[epidermal growth factor(EGF),vasoactive intestinal peptide(VIP),substance P,motilin,gastrin],inflammatory factors indexes[C-reactive pro-tein(CRP),procalcitonin(PCT),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],nutritional status indexes[hemo-globin(Hb),retinol-binding protein(RBP),transferrin(TRF),prealbumin(PAB),albumin(ALB)]and immune function indexes[lymphocyte count,neutrophil count,helper T cell(Th)1/Th2,CD4^(+)/CD8^(+)]were compared between the two groups.Result The operation time in laparoscopic group was significantly longer than that in open group,and the intra-operative blood loss was significantly less than that in open group,the recovery time of bowel sounds,first exhaust time,first defecation time,first time getting out of bed,and hospitalization time were significantly shorter than those in open group,and the differences were statistically significant(P<0.01).Three days after surgery,the levels of EGF,substance P,VIP,CRP,PCT,TNF-α,IL-6,and neutrophil count in laparoscopic group were lower than those in open group,while the levels of motilin,gastrin,Hb,RBP,TRF,PAB,ALB,and lymphocyte count,Th1/Th2,CD4^(+)/CD8^(+)were higher than those in open group,and the differences were statistically significant(P<0.05).Conclusion Laparoscopic radical surgery is beneficial for promoting the recovery of gastrointestinal function in colorectal cancer patients,and can reduce inflammato-ry reactions,improve immune function and nutritional status.

关 键 词：结直肠癌 腹腔镜根治术 胃肠功能 炎性反应 免疫功能 

分 类 号：R735.3[医药卫生—肿瘤]