腹腔镜及开腹手术对结肠癌患者免疫功能和应激指标的影响分析
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摘要
目的研究腹腔镜及开腹两种手术方式对结肠癌患者的免疫功能和应激指标的影响。方法将80例结肠癌患者随机分为腹腔镜组和开腹组,每组40例,分别进行腹腔镜手术和开腹手术,检测并比较两组患者手术前、术后第1天、术后第3天和术后第5天的免疫功能指标和应激指标。结果与手术前相比,手术后两组患者的CD3+、CD4+、CD8+、CD4+/CD8+及免疫球蛋白A(IgA)、IgG、IgM水平均先降低,然后随着时间的增加而逐渐升高,皮质醇及肾上腺素水平均先升高,然后随着时间的增加而逐渐降低。术后第1天、术后第3天和术后第5天,开腹组患者的CD3+、CD4+、CD8+、CD4+/CD8+及IgG、IgM水平均低于腹腔镜组,皮质醇、醛固酮及肾上腺素水平均高于腹腔镜组,差异均有统计学意义(P﹤0.05)。结论相对于开腹手术,腹腔镜手术对结肠癌患者的免疫功能和应激创伤影响较小,有利于患者术后机体的快速恢复。
Objective To study the effect of laparoscopic surgery and laparotomy on the immune function and stress indicators in patients with colon cancer. Method A total of 80 patients with colorectal cancer were randomized into two groups, receiving laparoscopic surgery or laparotomy surgery, with 40 cases in each group, respectively. The immune function and stress indicators before surgery, and on the 1 st, 3 rd, and 5 thday after the surgery were measured and compared. Result The levels of CD3+, CD4+, CD8+and CD4+/CD8+, as well as immunoglobulin A(IgA), IgG, and IgM in both groups were decreased immediately after surgery, while began to gradually increase as time elapsed, while the level of cortisol, aldosterone, and epinephrine exhibited a reverse trend of first increasing followed by subsequent decreasing. On the 1 st, 3 rd, and 5 thday after operation, the levels of CD3+, CD4+, CD8+, CD4+/CD8+, IgG and IgM in laparotomy group were lower compared to laparoscopic surgery group, while the levels of cortisol and epinephrine were higher instead, indicating statistically significant difference(P<0.05). Conclusion Compared with laparotomy, the laparoscopic surgery imposes little impact on the patient's immune function and stress response, facilitating the rapid recovery for the patients with colon cancer.
Objective To study the effect of laparoscopic surgery and laparotomy on the immune function and stress indicators in patients with colon cancer. Method A total of 80 patients with colorectal cancer were randomized into two groups, receiving laparoscopic surgery or laparotomy surgery, with 40 cases in each group, respectively. The immune function and stress indicators before surgery, and on the 1 st, 3 rd, and 5 thday after the surgery were measured and compared. Result The levels of CD3+, CD4+, CD8+and CD4+/CD8+, as well as immunoglobulin A(IgA), IgG, and IgM in both groups were decreased immediately after surgery, while began to gradually increase as time elapsed, while the level of cortisol, aldosterone, and epinephrine exhibited a reverse trend of first increasing followed by subsequent decreasing. On the 1 st, 3 rd, and 5 thday after operation, the levels of CD3+, CD4+, CD8+, CD4+/CD8+, IgG and IgM in laparotomy group were lower compared to laparoscopic surgery group, while the levels of cortisol and epinephrine were higher instead, indicating statistically significant difference(P<0.05). Conclusion Compared with laparotomy, the laparoscopic surgery imposes little impact on the patient's immune function and stress response, facilitating the rapid recovery for the patients with colon cancer.
引文
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[9]严健,原永明,张舒,等. CD3+、CD4+、CD8+T淋巴细胞亚群在肿瘤患者外周血中检测的临床意义[J].检验医学,2013, 28(10):901-903.
[10]朱东波,姚斌,姚鑫,等.腹腔镜与开腹手术对大肠癌免疫功能的影响对比[J].中国现代普通外科进展, 2017, 20(11):919-921.
[11]李松伟.腹腔镜与传统开腹手术对结直肠癌患者术后免疫功能及生理反应的影响[J].河南外科学杂志, 2017, 23(1):27-28.
[12]邱东达.比较腹腔镜手术与常规开腹手术对右半结肠癌切除术后创伤应激的影响[J].结直肠肛门外科, 2018, 24(1):31-34.
[13]杨建治,于燕,黄崇亚.多模式镇痛对结肠癌根治术患者细胞因子及皮质醇水平的影响[J].昆明医科大学学报,2016, 37(9):116-119.
[2]曹广,陶振洲,伍冀湘.腹腔镜及开腹手术在大肠癌治疗中的临床应用及其对机体免疫功能的影响[J].首都医科大学学报, 2012, 33(1):59-62.
[3]杜建军,王园园,郭雄飞,等.腹腔镜手术治疗结肠癌的围术期应激反应及免疫功能观察[J].结直肠肛门外科,2015, 21(6):413-417.
[4]程涛,樊理华,滕向龙,等.腹腔镜手术与开腹手术对结肠癌患者胃肠功能和免疫功能的影响[J].中国现代医生,2016, 54(35):15-17; 20.
[5]于益芝,曹雪涛.调节性T细胞在肿瘤免疫和肿瘤免疫治疗中的作用[J].中国肿瘤生物治疗杂志, 2010, 17(1):1-6.
[6]梁新强,刘海洲,利基林,等.大肠癌患者手术前后外周血淋巴细胞的变化及其临床意义[J].吉林医学, 2012, 33(27):5832-5834.
[7]王永森,谢贻祥,王传思,等.腔镜与传统根治术对结直肠癌患者机体应激及细胞免疫力影响的对比研究[J].中华全科医学, 2016, 14(8):1279-1281.
[8] Kim K, An HJ, Jun SH, et al. Single step isolation and activation of primary CD3+T lymphocytes using alcohol-dispersed electrospun magnetic nanofibers[J]. Nano Lett,2012, 12(8):4018-4024.
[9]严健,原永明,张舒,等. CD3+、CD4+、CD8+T淋巴细胞亚群在肿瘤患者外周血中检测的临床意义[J].检验医学,2013, 28(10):901-903.
[10]朱东波,姚斌,姚鑫,等.腹腔镜与开腹手术对大肠癌免疫功能的影响对比[J].中国现代普通外科进展, 2017, 20(11):919-921.
[11]李松伟.腹腔镜与传统开腹手术对结直肠癌患者术后免疫功能及生理反应的影响[J].河南外科学杂志, 2017, 23(1):27-28.
[12]邱东达.比较腹腔镜手术与常规开腹手术对右半结肠癌切除术后创伤应激的影响[J].结直肠肛门外科, 2018, 24(1):31-34.
[13]杨建治,于燕,黄崇亚.多模式镇痛对结肠癌根治术患者细胞因子及皮质醇水平的影响[J].昆明医科大学学报,2016, 37(9):116-119.
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