作者：邓浩

单位：武汉市红十字会医院 普通外科，湖北 武汉 430015

Authors:  DENG Hao

Unit:  Department of general surgery, Wuhan Red Cross hospital, Wuhan 430015, Hubei, China

摘要：

目的  探讨腹腔镜完整结肠系膜切除术(CME)对右半结肠癌患者炎症反应及免疫功能的影响。方法  选取2014年1月～2018年1月在我院实施完整结肠系膜切除术的124例右半结肠癌患者的临床资料,根据手术方法不同分为腹腔镜组和开腹组,每组62例,腹腔镜组采用腹腔镜下中线入路右半结肠CME手术;开腹组采用传统开腹中线入路右半结肠CME手术,比较两组患者手术相关指标、手术前后炎性反应指标、免疫功能指标变化以及不良反应。结果  腹腔镜组在出血量、首次排气时间、住院时间上低于开腹组,手术时间上高于开腹组,差异有统计学意义(P<0.05);炎症反应指标[白介素-6、C反应蛋白]显著低于开腹组,差异有统计学意义(P<0.05);免疫指标[CD4+、CD4+/CD8+]较开腹组升高,CD8+则降低,差异有统计学意义(P<0.05);腹腔镜组不良反应率6.45%(4/62)低于开腹组9.68%(6/62),差异有统计学意义(P<0.05)。结论  腹腔镜下中线入路CME手术对右半结肠癌患者可显著减少炎症反应,提高患者免疫功能,安全性高,应用价值较高。

关键词： 腹腔镜下CME手术; 右半结肠癌; 炎症反应; 免疫指标

Abstract：

Objective  To investigate the effects of laparoscopic complete mesenterectomy (CME) on inflammatory response and immune function in patients with right colon cancer. Methods  124 patients with right semicolon carcinoma who underwent complete mesenterectomy in our hospital from January 2014 to January 2018 were selected. According to different surgical methods, they were divided into laparoscopic group and laparotomy group, 62 cases each group. Laparoscopic group received laparoscopic midline approach CME operation in right colon, and the laparotomy group received CME operation in right colon by traditional midline approach. Intraoperative and postoperative related indicators, inflammatory response index and immune function index and adverse reactions were compared between the two groups. Results  The amount of bleeding, the time of first exhaust and the time of hospitalization in the laparoscopic group were lower than that in the laparotomy group, and the time of surgery was higher than that in the laparotomy group, with statistically significant differences (P<0.05). Inflammatory response indexes (interleukin-6, c-reactive protein) were significantly lower than that of the laparotomy group, with statistically significant differences (P<0.05). Immune indexes (CD4+、CD4+/CD8+) were increased and CD8+ decreased compared with the laparotomy group, with statistically significant differences (P<0.05).The adverse reaction rate of the laparoscopic group was 6.45% (4/62) lower than that of the laparotomy group 9.68% (6/62), and the difference was statistically significant (P<0.05). Conclusions  Laparoscopic midline CME is effective for right colon cancer, which is helpful to reduce inflammatory reaction, improve immune function and high safety. It is worth disseminated in clinical practice.

Key Words:  Laparoscopic CME surgery; Night colon cancer; Inflammatory response; Immune index