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结肠镜联合腹腔镜治疗结直肠癌效果及对Th1/Th2漂移、应激反应的影响 预览

Combined laparoscopic-colonoscopic approach in the treatment of colorectal cancer and its effect on Th1/Th2 balance and stress response
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摘要 目的探究结肠镜联合腹腔镜治疗结直肠癌效果及对辅助性T细胞Th1/Th2漂移、应激反应的影响。方法选取2016年10月至2018年10月期间广州中医药大学金沙洲医院收治的82例结直肠癌患者为研究对象,依据治疗术式不同分为观察组(n=41)、对照组(n=41)。对照组予以开腹结直肠癌根治术,观察组在结肠镜联合腹腔镜下实施结直肠癌根治术。对比两组手术相关指标、术后并发症发生情况及术前、术后1 d、术后3 d的血清应激指标[皮质醇(COR)、肾上腺素(E)、去甲肾上腺素(NE)]、血清Th1、Th2、Th1/Th2及Th1/Th2有关细胞因子[白细胞介素-10 (IL-10)、白细胞介素-6 (IL-6)、干扰素-γ(IFN-γ)]水平。结果两组淋巴结清扫数目、手术时间对比,差异均无统计学意义(均P> 0.05);观察组住院时间、首次肛门排气时间较对照组短,术中出血量较对照组少,差异均有统计学意义(均P <0.05);观察组术后并发症发生率为7.32%,低于对照组的24.39%,差异有统计学意义(P <0.05);两组术后1 d、3 d血清COR、E、NE水平均较术前增高,但观察组低于对照组,差异均有统计学意义(均P <0.05);两组术后1 d、3 d血清Th1、Th1/Th2水平较术前降低,但观察组高于对照组,血清Th2水平较术前增高,但观察组低于对照组,差异均有统计学意义(均P <0.05);两组术后1 d、3 d血清IL-10、IL-6水平较术前增高,但观察组低于对照组,血清IFN-γ水平较术前降低,但观察组高于对照组,差异均有统计学意义(均P <0.05)。结论对结直肠癌患者采取结肠镜联合腹腔镜治疗可减轻手术创伤,加速术后恢复,降低并发症发生风险,且机体应激反应轻,对免疫功能影响小。 Objectives To investigate the clinical effect of combined laparoscopic-colonoscopic approach in the treatment of colorectal cancer and its effect on T helper 1(Th1)/T helper 2(Th2) balance and stress response. Methods Eighty-two patients with colorectal cancer treated in Jinshazhou Hospital of Guangzhou University of Chinese Medicine between October 2016 and October 2018 were divided into treatment group(n = 41) and control group(n= 41) depending on the types of surgery. Patients in the control group received open surgery, while patients in the treatment group received combined laparoscopic-colonoscopicsurgery. The followings were compared between the two groups: surgical outcomes, postoperative complications, serum indicators of stress(COR, E, and NE), serum levels of Th1 and Th2, Th1/Th2, and related cytokines(IL-10, IL-6, IFN-γ) before surgery,and at day 1 and day 3 after surgery. Results There was no significant difference between the two groups in lymph node yield and duration of surgery(P > 0.05). Patients in the treatment group had significantly shorter duration of hospitalization and time to first bowel movement, as well as fewer intraoperative blood loss than those in the control group(P < 0.05). Incidence of complications was 7.32% in the treatment group, which was significantly lower than that in the control group(24.39%, P < 0.05).The followings were significantly higher at day 1 and 3 after surgery than before surgery in both groups: serum levels of COR,E, NE, Th2, Il-10 and IL-6, which were all significantly lower in the treatment group than in the control group(P < 0.05).The followings were significantly lower at day 1 and day 3 after surgery than before surgery: serum levels of Th1 and IFN-γ,and Th1/Th2, these were all significantly higher in the treatment group than in the control group(P < 0.05). Conclusion Combined laparoscopic-colonoscopic approach for colorectal cancer could minimize surgical wound, promote postoperative recovery, lower the risk of complication. It is also associated with l
作者 王木勇 Wang Muyong(Department of General Surgery, Jinshazhou Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510080, Guang? dong, China)
出处 《结直肠肛门外科》 2019年第4期452-457,共6页 Journal of Colorectal & Anal Surgery
关键词 结直肠癌 结肠镜 腹腔镜 TH1/TH2漂移 应激反应 colorectal cancer colonoscopy laparoscopy Th1/Th2 balance stress response
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