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目的比较腹腔镜辅助与开腹手术根治直肠癌的近期疗效和对机体免疫功能的影响,为临床治疗提供依据。方法将2013年1月至2015年1月收治的140例结肠癌患者,按患者治疗意愿分为腹腔镜组与开腹组各70例。开腹组行传统开腹手术,腹腔镜组行腹腔镜辅助下治疗直肠癌。对比两组患者围手术期相关临床指标、术后并发症发生率及对机体免疫反应的影响。结果与开腹组比较,腹腔镜组术中出血量较少、切口较短,肛门排气时间、下床活动时间、术后住院时间、导管留置时间均较短,差异均有统计学意义(P均<0.05)。两组手术时间及淋巴清扫数量比较差异无统计学意义(P均>0.05)。腹腔镜组、开腹组术后总并发症发生率分别为7.1%、17.1%,腹腔镜组并发症发生率较开腹组有所降低,但差异无统计学意义(P>0.05)。术后1、3 d,两组T淋巴细胞亚群(CD4+、CD8+、CD4+/CD8+)、自然杀伤(NK)细胞及淋巴细胞计数比较无统计学差异(P均>0.05);但血清CRP、IL-6水平均较术前明显增高,其中术后1 d最高,术后3 d较1 d回落,差异均有统计学意义(P<0.05,P<0.01),且腹腔镜组患者术后CRP、IL-6水平均低于开腹组(P均<0.05)。结论腹腔镜下直肠癌根治术具有微创、患者恢复快及对机体免疫功能损伤小等优点,且在降低并发症发生率方面有望获益。
Objective To compare the short-term curative effect of laparoscopic assisted and laparotomy on radical resection of colorectal cancer and its influence on immune function, and provide the basis for clinical treatment. Methods One hundred and seventy patients with colon cancer who were treated from January 2013 to January 2015 were divided into laparoscopic group and laparotomy group according to the patient’s treatment intention. The laparotomy group underwent traditional laparotomy and laparoscopic laparoscopic assisted treatment of rectal cancer. The perioperative clinical indexes, the incidence of postoperative complications and the impact on the immune response were compared between the two groups. Results Compared with the open group, laparoscopic group had less bleeding, shorter incision, anal exhaust time, ambulation time, postoperative hospital stay and catheter indwelling time, the differences were statistically significant ( P <0.05). There was no significant difference in the operation time and the number of lymphadenectas between the two groups (all P> 0.05). The incidence of postoperative complications in laparoscopic group and open group were 7.1% and 17.1% respectively. The incidence of complications in laparoscopic group was lower than that in open group, but the difference was not statistically significant (P> 0.05). There was no significant difference in T lymphocyte subsets (CD4 +, CD8 +, CD4 + / CD8 +), natural killer (NK) cells and lymphocyte count between the two groups on the 1st and 3rd postoperative day (P> 0.05) (P <0.05, P <0.01), and the level of IL-6 in the laparoscopic group was significantly higher than that before the operation CRP, IL-6 levels were lower than the open group (P all <0.05). Conclusions Laparoscopic radical resection of rectal cancer with minimally invasive, rapid recovery of patients and immune function damage and other advantages, and in reducing the incidence of complications is expected to benefit.