腹腔镜手术与传统开腹手术对老年结肠癌患者血清炎性因子水平及远期疗效的影响

摘要

目的 探讨腹腔镜手术与传统开腹手术对老年结肠癌患者血清炎性因子水平及远期疗效的影响.方法 收集2013年1月-2014年6月暨南大学附属第一医院胃肠外科住院治疗的110例行结肠癌根治术的患者,随机分为腔镜组和开腹组,每组55例.开腹组患者行传统开腹手术,腔镜组患者行腹腔镜下结肠癌根治术,记录比较患者围手术期指标(手术时间、淋巴结清除数、术中出血量、术后胃肠功能恢复时间、住院时间等),观察比较患者治疗前后的血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)水平.结果 与开腹组相比,腔镜组患者的手术时间较短,术中出血量较少,住院时间以及胃肠功能恢复时间较短,肺部感染发生率、肠梗阻发生率较低,差异均具有统计学意义(P<0.05,P<0.01);同时,与开腹组相比,2组患者的淋巴结清除率、切口感染发生率、局部复发率、切口种植发生率以及远处转移发生率差异均无统计学意义(P>0.05).与治疗前相比,2组患者的TNF-α和IL-6水平均下降,CRP水平均升高,差异均具有统计学意义(P<0.01),而腔镜组TNF-α、IL-6、CRP水平均低于开腹组(P<0.01).结论 腔镜下结肠癌根治术与传统手术相比,能有效降低患者TNF-α、IL-6水平,降低CRP升高幅度,减少术中出血量,缩短术后胃肠道功能恢复时间以及术后住院天数,降低降低肺部感染、术后肠梗阻等并发症,符合快速康复外科理念,在临床上值得广泛应用.%Objective To explore the influence of serum tumor necrosis factor levels and long term curative effect of traditional open surgery and laparoscopic surgery for elderly patients with colon cancer patients.Methods One hundred and twenty cases of colorectal cancer patients from the department of gastrointestinal surgery in the First Affiliated Hospital of Jinan University from January 2013 to June 2014 were randomly divided into experimental group and control group, with 55 cases in each group.The patients in the control group were treated with traditional open surgery;the patients in the experimental group were treated with laparoscopic radical resection of colon cancer.Serum tumor necrosis factorα (TNF-α),Interleukin 6 (IL-6), C reactive protein (CRP) between the two groups before and after treatment, amount of bleeding,operation time, intraoperative curative effect (hospital time, gastrointestinal function recovery time, the number of lymph node dissection, incision infection and pulmonary infection) and long term efficacy (intestinal obstruction, local recurrence, incision implantation and distant metastasis) level were compared and observed.Results Compared with before treatment, the TNF-α,IL-6 levels of patients in two groups were decreased, CRP levels were increased,the differences were statistically significant (P<0.05,P<0.01).Compared with the control group, the operation time was shorter, the amount of bleeding was less, TNF-α,IL-6 and CRP levels were lower, the hospitalization time,gastrointestinal function recovery time were shorter, the incidence of pulmonary infection, intestinal obstruction were lower in the experimental group, the differences were statistically significant (P<0.01).In the meantime, compared with the control group, the lymph node clearance, incision infection rate, local recurrence rate,incision implantation incidence and distant metastasis incidence of the two groups shown no significant difference(P>0.05).Conclusion Compared with traditional surgery, laparoscopic colorectal cancer radical surgery can effectively reduce the patients' TNF-α,IL-6 level, increase the level of CRP and reduce the amount of bleeding, shorten the time of postoperative recovery of gastrointestinal function and postoperative hospital stay, reduce pulmonary infection, intestinal obstruction and other complications, in line with the concept of rapid rehabilitation surgery, worthy of in clinical application.