传统开腹与腹腔镜手术对老年直肠癌患者围手术期应激反应和免疫功能的比较

摘要

目的 比较传统开腹与腹腔镜手术对老年直肠癌患者围手术期应激反应和免疫功能的影响.方法 选取2014年1月至2015年12月老年直肠癌患者80例(年龄>60岁),随机分为传统开腹手术组和腹腔镜手术组,每组各40例,比较两组患者手术时间、术后首次肛门排气时间、住院时间等指标,并分别在术前1d及术后第1天、第7天取外周静脉血,测定白介素6(IL-6)、白介素10(IL-10)、肿瘤坏死因子α(TNF-α)、CD3+、CD4+、CD8+T细胞含量,比较两组患者手术后应激反应、免疫反应术后并发症等指标.结果 与传统开腹手术组比较,腹腔镜手术组患者手术时间、术后首次肛门排气时间、住院时间均较短,差异有统计学意义(P<0.05);两组手术患者术前1d各项指标差异无统计学意义(P>0.05);术后第1天和第7天腹腔镜组患者血清L-6、IL-10和TNF-α水平明显低于传统开腹组(P<0.05);术后第1天,两组患者CD3+,CD4+、CD8+T细胞含量差异无统计学意义(P>0.05);术后第7天,腹腔镜手术组CD3+,CD4+、CD8+T细胞含量明显高于传统开腹手术组,差异有统计学意义(P<0.05).腹腔镜组术后早期下床活动(<3d)、镇痛剂使用(<1.5d)时间明显短于传统开腹组,差异有统计学意义(P<0.05).结论 腹腔镜结直肠癌根治术较传统手术对老年直肠癌患者围手术期机体细胞免疫功能和应激反应的影响更小.%Objective To compare the difference of laparoscopic surgery and laparotomy onsystemic stress response and immune function in elderly patients with rectal cancer.Methods80 elderly patients(age over60)with rectal cancer in our department from January2014 to December 2015 were selected and then randomly assigned to traditional laparotomy group and laparoscopic group,the number of each group was40. The operation duration and the first anus exhaust time after operation and hospital stays were compared. Blood samples were colected in baseline and1,7 days after surgery to detect the level of interleukin6(IL-6),interleukin10(IL-10),tumor necrosis factor α(TNF-α),CD3+,CD4+ and CD8+ to reflect the change of systemic stress response and immune function.ResultsCompared with the traditional laparotomy group,the operation duration and the first anus exhaust time after operation and hospital stays were significantly decreased(P<0.05).There was no difference of statistics in each markers in pre-operation. The level of IL-6,IL-10 and TNF-α were significantly decreased in laparoscopic group after operation(P<0.05). There was no difference of statistics in the levels of CD3+,CD4+ and CD8+ in the first day after surgery between two groups.However,significantly increase of CD3+,CD4+ and CD8+ were observed in laparoscopic group on7th days after surgery. The postoperative complications of laparoscopic group in early ambulation(<3d),postoperative analgesic use(<1.5d)time was significantly lower than that of the conventional laparotomy group(P<0.05). Conclusion The impact of systemic stress response and immune response are less in elderly patients with rectal cancer treated with laparoscopic surgery.