3D腹腔镜全结肠系膜切除术治疗右半结肠癌的临床评价  

Clinical evaluation of 3D laparoscopy complete mesocolic excision in the treatment of right-sided colon cancer

作　　者：王雷鸣 叶松 孙学思 WANG Leiming;YE Song;SUN Xuesi(Department of General Surgery,Shuyang Hospital,Jiangsu,Shuyang 223600,China)

机构地区：[1]沭阳医院普外科,江苏沭阳223600

出　　处：《中国医药科学》2025年第6期77-80,84,共5页China Medicine And Pharmacy

基　　金：江苏省高校重点实验室开放课题(XZSYSKF2023036)。

摘　　要：目的 分析比较3D腹腔镜下行全结肠系膜切除术(CME)与开腹手术治疗右半结肠癌的临床效果差异。方法 选取2020年1月至2023年12月沭阳医院收治的右半结肠癌患者资料进行分析,根据术式分为3D腹腔镜组(34例)与开腹组(29例),观察并比较两组患者围手术期一般情况,手术前后T淋巴细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、炎症因子肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP),及肿瘤标志物癌胚抗原(CEA)、糖类抗原-199(CA-199)水平变化,随访观察术后并发症发生情况。结果 3D腹腔镜组术中出血量及住院时间明显少于开腹组,差异有统计学意义(P<0.05)。两组术后7 d的CD4^(+)和CD4^(+)/CD8^(+)水平均较术前1 d明显降低,开腹组术后7 d的CD8^(+)较术前1 d明显升高,3D腹腔镜组术后7 d的T细胞亚群水平明显优于开腹组,差异有统计学意义(P<0.05)。术后7 d,开腹组TNF-α、CRP水平较术前1 d明显升高,3D腹腔镜组CRP较术前1 d明显升高,3D腹腔镜组TNF-α、CRP水平明显低于开腹组,差异有统计学意义(P<0.05)。两组患者术后1个月CEA、CA-199水平较术前1 d均明显降低,差异有统计学意义(P<0.05),但两组术后1个月CEA、CA-199水平比较,差异无统计学意义(P>0.05)。随访6个月两组均未见复发病例,两组患者并发症总发生率比较,差异无统计学意义(P>0.05)。结论 与开腹治疗右半结肠癌相比,3D腹腔镜CME造成的创伤较小,免疫反应和炎症反应较轻,有利于减少术中出血量及住院时间,促进患者术后康复。Objective To analyze and compare the differences in clinical efficacies of 3D laparoscopy complete mesocolic excision(CME)and laparotomy in the treatment of right-sided colon cancer.Methods The data of patients with right-sided colon cancer admitted to and treated in Shuyang Hospital from January 2020 to December 2023 were selected and analyzed,and they were divided into the 3D laparoscopy group(n=34)and the laparotomy group(n=29)according to the operation methods.The general situation of two groups of patients during the perioperative period was observed and compared,including T lymphocyte subsets(CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),changes in levels of inflammatory factors such as tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and tumor markers carcinoembryonic antigen(CEA)and carbohydrate antigen-199(CA-199).The occurrence of postoperative complications was followed up to observe.Results The intraoperative hemorrhage volume and hospitalization time in the 3D laparoscopy group were obviously lower than those in the laparotomy group,with statistically significant differences(P<0.05).On the 7th postoperative day,the levels of CD4^(+)and CD4^(+)/CD8^(+)in both groups were significantly lower than those on the 1st preoperative day,while CD8^(+)in the laparotomy group was significantly higher than that on the 1st preoperative day.On the 7th postoperative day,the level of T cell subsets in the 3D laparoscopy group was significantly superior to that in the laparotomy group,with statistically significant differences(P<0.05).On the 7th postoperative day,the levels of TNF-αand CRP in the laparotomy group were significantly higher than those on the 1st preoperative day,and CRP in the 3D laparoscopy group was significantly higher than that on the 1st preoperative day,and the levels of TNF-αand CRP in the 3D laparoscopy group on the 7th postoperative day were significantly lower than those in the laparotomy group,with statistically significant differences(P<0.05).After the 1st postoperative month,the levels of CEA

关 键 词：3D腹腔镜 全结肠系膜切除术 右半结肠癌 开腹手术 

分 类 号：R735.35[医药卫生—肿瘤]