基于应激反应指标探究腹腔镜辅助下经自然腔道取出标本术对Ⅲ期结直肠癌术后患者的临床价值  

The clinical value of laparoscopic-assisted natural orifice specimen extraction surgeryin postoperative patients with stageⅢcolorectal cancer based on stress response indexes

作　　者：司云飞 王昀 Si Yunfei;Wang Yun(Department of Abdominal Surgery,Mudanjiang Cancer Hospital,Mudanjiang 157000,China;Department of Laboratory,Hongqi Hospital Affiliated to Mudanjiang Medical College,Mudanjiang 157000,China)

机构地区：[1]牡丹江市肿瘤医院腹外一科,牡丹江157000 [2]牡丹江医学院附属红旗医院检验科,牡丹江157000

出　　处：《中国医师进修杂志》2025年第4期353-357,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的基于应激反应指标探究腹腔镜辅助下经自然腔道取出标本(NOSES)术对Ⅲ期结直肠癌术后患者的临床价值。方法回顾性选择2021年1月至2023年1月牡丹江市肿瘤医院、牡丹江医学院附属红旗医院收治的86例结直肠癌患者为研究对象,其中43例行常规腹腔镜下结直肠癌根治术(LCR)治疗(对照组),43例行腹腔镜下NOSES术治疗(观察组),比较两组术后肿瘤标志物、应激反应指标和体液免疫指标水平变化,并比较两组术后并发症发生情况。结果两组术后2周癌胚抗原、糖类抗原(CA)19-9、CA242、CA125水平较术前降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。观察组术后3 d超氧化物歧化酶水平高于对照组[(68.45±8.30)kU/L比(59.64±8.18)kU/L],丙二醛水平低于对照组[(8.84±2.03)mmol/L比(10.26±2.11)mmol/L],差异有统计学意义(P<0.05)。观察组术后3 d免疫球蛋白(Ig)A、IgM、IgG水平高于对照组[(1.59±0.40)g/L比(1.33±0.36)g/L、(1.25±0.31)g/L比(1.03±0.26)g/L、(8.75±2.12)g/L比(6.89±2.05)g/L],差异有统计学意义(P<0.05)。两组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论腹腔镜辅助下NOSES术在Ⅲ期结直肠癌治疗中能够在有效改善患者肿瘤标志物水平的同时,减轻手术对患者造成的应激反应和免疫损伤,具有更好的微创优势,且安全性有保障。ObjectiveTo investigate the clinical value of laparoscopic-assisted natural orifice specimen extraction surgery(NOSES)in postoperative patients with stageⅢcolorectal cancer based on stress response indexes.MethodsA total of 86 patients with colorectal cancer treated in Mudanjiang Cancer Hospital and Hongqi Hospital Affiliated to Mudanjiang Medical College from January 2021 to January 2023 were retrospectively selected as the study objects,of which 43 patients underwent conventional laparoscopic radical resection of colorectal cancer(LCR)treatment(control group)and 43 patients underwent NOSES treatment(observation group).The changes of tumor markers,stress response indexes and humoral immunity indexes were compared between the two groups before and aftertreatment,and the incidence of postoperative complications were compared between the two groups.ResultsThe levels of carcinoembryonic antigen(CEA),carbohydrate antigen(CA)19-9,CA242 and CA125 in the two groups were decreased 2 weeks after surgery(P<0.05),but there were no statistical differences between the two groups(P>0.05).The level of superoxide dismutase(SOD)in the observation group was higher than that in the control group 3 d after operation:(68.45±8.30)kU/L vs.(59.64±8.18)kU/L;the level of malondialdehyde(MDA)was lower than that in the control group:(8.84±2.03)mmol/L vs.(10.26±2.11)mmol/L,there were statistical differences(P<0.05).The levels of immunoglobulin(Ig)A,IgM and IgG in the observation group were higher than those in the control group 3 d after operation:(1.59±0.40)g/L vs.(1.33±0.36)g/L,(1.25±0.31)g/L vs.(1.03±0.26)g/L,(8.75±2.12)g/L vs.(6.89±2.05)g/L,there were statistical differences(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).ConclusionsLaparoscopic-assisted NOSES in the treatment of stageⅢcolorectal cancer can effectively improve the level of tumor markers of patients,reduce the stress reaction and immune damage caused by surgery to the patients and ens

关 键 词：结直肠肿瘤 经自然腔道取出标本术 腹腔镜结直肠癌根治术 应激反应 手术后并发症 

分 类 号：R735.3[医药卫生—肿瘤]