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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (05) : 332 -336. doi: 10.3877/cma.j.issn.1674-0793.2018.05.011

所属专题： 文献；

论著

结肠癌患者腹腔镜切除术后创伤应激及微转移的改变
王鹏1,†(), 占三辉1, 柏伟华1, 于海洋1   
  1. 1. 224000　盐城市亭湖区人民医院普外科
  • 收稿日期:2017-12-07 出版日期:2018-10-01
  • 通信作者: 王鹏

Changes of trauma stress and micrometastasis after laparoscopic resection in patients with colon cancer

Peng Wang1,†(), Sanhui Zhan1, Weihua Bai1, Haiyang Yu1   

  1. 1. Department of General Surgery, People’s Hospital of Tinghu District, Yancheng 224000, China
  • Received:2017-12-07 Published:2018-10-01
  • Corresponding author: Peng Wang
  • About author:
    Corresponding author: Wang Peng, Email:
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引用本文：

王鹏, 占三辉, 柏伟华, 于海洋. 结肠癌患者腹腔镜切除术后创伤应激及微转移的改变[J]. 中华普通外科学文献(电子版), 2018, 12(05): 332-336.

Peng Wang, Sanhui Zhan, Weihua Bai, Haiyang Yu. Changes of trauma stress and micrometastasis after laparoscopic resection in patients with colon cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(05): 332-336.

目的

对比分析腹腔镜结肠癌切除术对结肠癌患者创伤应激及微转移的影响，为治疗结肠癌提供理论依据。

方法

以2011年5月至2016年5月盐城市亭湖区人民医院确诊为结肠癌并实施治疗的98例患者为研究对象，按照随机数字法分为腹腔镜组和开腹组，各49例。开腹组患者采取传统手术方法治疗，腹腔镜组采用腹腔镜结肠癌切除术治疗，密切观察记录两组患者外周血白细胞计数（WBC）、中性粒细胞（N）、C反应蛋白（CRP）、皮质醇（Cor）水平以及腹腔冲洗液癌胚抗原（CEA）、多巴脱羧酶（DDC）浓度等创伤应激和微转移指标。

结果

（1）腹腔镜组患者手术切口长度、手术时间、术中出血量、住院时间、肠胃功能恢复时间、术后下床活动时间和术后排气时间均优于开腹组，差异有统计学意义（均P<0.05）；腹腔镜组的并发症发生率、复发率显著低于开腹组，生存率显著高于开腹组，差异均有统计学意义（χ2=8.023、4.638、2.368，P=0.001、0.002、0.004）。（2）两组患者外周血应激指标术前差异无统计学意义，在手术结束时均有明显升高，WBC、Cor、N在术后1 d时达到最高值，CRP质量浓度则在术后3 d时达到最大值。腹腔镜组患者术后0、1 d时的外周血Cor质量浓度均显著低于开腹组患者同期（P<0.05），而术后3、7 d时差异无统计学意义；两组患者手术前后各检测时间点的外周血N水平对比差异无统计学意义；腹腔镜组患者术后1、3 d时的外周血CRP质量浓度均显著低于开腹组患者同期（P<0.05），而术后0、7 d时差异无统计学意义。（3）两组患者手术开始时腹腔冲洗液CEA、DDC质量浓度对比，差异无统计学意义（t=1.458、1.024，P=0.446、0.573）；手术结束时腹腔镜组患者CEA、DDC质量浓度（μg/L）分别为1 495.8±657.4、121.5±48.6，明显低于开腹组患者的2 873.8±1 752.1、165.7±58.7，差异有统计学意义（t=2.861、2.534，P=0.011、0.012）。

结论

腹腔镜结肠癌切除术可缩短患者住院时间，提高治疗效果和患者生存率，结肠癌患者的创伤小，肿瘤发生微转移的概率低，值得临床关注。

关键词: 结肠肿瘤, 结肠切除术, 应激障碍，创伤性, 肿瘤转移
Objective

To compare the effects of laparoscopic colon resection on trauma stress and micrometastasis in patients with colon cancer.

Methods

From May 2011 to May 2016, a total of ninety-eight patients admitted to People’s Hospital of Tinghu District who were diagnosed with colon cancer were selected. According to the random number, they were divided into laparoscopic group (undergoing laparoscopic colon cancer resection) and laparotomy group (treated with traditional laparotomy), with 49 patients in each group, respectively. The concentration of white blood cell (WBC), neutrophil (N), C-reactive protein (CRP), cortisol (Cor) in peripheral blood, and carcinoembryonic antigen (CEA), dopa decarboxylase (DDC) concentration in peritoneal wash fluid were detected and compared.

Results

(1) The length of incision, operative time, intraoperative blood loss, hospitalization time, gastrointestinal function recovery time, postoperative ambulation time and postoperative exhaust time in laparoscopic group were all better than those in the laparotomy group (all P<0.05). The incidence of complications and recurrence rate in the laparoscopy group were significantly lower than those in the laparotomy group, and the survival rate was significantly higher (χ2=8.023, 4.638, 2.368, P=0.001, 0.002, 0.004). (2) There was no significant difference in the preoperative peripheral blood stress between the two groups, but it showed significant increase at the end of the operation. WBC, Cor, and N reached the highest value 1 d after operation, while CRP 3 d after operation. The concentration of Cor in peripheral blood at 0 and 1 d after operation in the laparoscopy group was significantly lower than that in the laparotomy group (P<0.05). The concentration of CRP in peripheral blood at 1 and 3 d after operation in the laparoscopy group was significantly lower than that in the laparotomy group (P<0.05). (3) The CEA and DDC concentration (μg/L) in the two groups showed no statistical significance differences (t=1.458, 1.024, P=0.446, 0.573). At the end of the operation, CEA and DDC concentration (μg/L) in the laparoscopic group were 1 495.8±657.4, 121.5±48.6 respectively, lower than 2 873.8±1 752.1, 165.7±58.7 in the laparotomy group obviously (t=2.861, 2.534, P=0.011, 0.012).

Conclusion

Laparoscopic resection of colon cancer can shorten the hospitalization time, and improve the therapeutic effect and the patients’ survival rate, with small trauma and lower probability of tumor micrometastasis.

Key words: Colonic neoplasms, Colectomy, Stress disorders, traumatic, Neoplasm metastasis
表1 两组结肠癌患者一般资料对比
组别 例数 年龄(岁, ±s) 男/女(例) 肿瘤直径(cm , ±s) 早期癌[例(%)] 进展期癌[例(%)] 病程(年, ±s)
腹腔镜组 49 66.6±10.1 27/22 2.1±0.5 21(42.9) 28(57.1) 1.07±0.8
开腹组 49 68.2±11.2 24/25 2.4±0.6 23(47.0) 26(53.0) 1.05±0.7
统计值 ? t=1.392 χ2=1.406 t=1.399 χ2=1.305 χ2=1.383 t=1.273
P值 ? 0.968 0.998 0.982 0.716 0.853 0.663
表2 两组结肠癌患者手术指标对比情况
组别 例数 手术时间(min) 切口长度(cm) 术中出血量(ml) 淋巴结清除个数(个) 术后排气时间(h) 术后下床活动时间(h) 肠胃功能恢复时间(d) 住院时间(d) 总并发症(%) 复发率(%) 生存率(%)
腹腔镜组 49 232.38±3.32 7.51±1.23 78.62±12.93 10.45±2.31 58.38±5.52 75.26±9.18 2.32±1.13 6.78±1.31 14.3 8.2 93.9
开腹组 49 299.58±7.26 13.85±2.31 187.42±33.54 11.02±2.42 85.85±8.79 103.21±17.56 7.62±0.98 12.54±1.87 30.6 24.5 79.6
统计值 ? 5.362a 3.386a 3.121a 1.356a 4.236a 4.896a 6.212a 5.387a 8.023b 4.638b 2.368b
P值 ? 0.001 0.002 0.002 0.231 0.002 0.002 0.001 0.001 0.001 0.002 0.004
表3 两组结肠癌患者外周血创伤应激指标水平变化（±s）
组别 时间点 WBC（×109/L） Cor（μg/L） N（%） CRP（mg/L）
腹腔镜组（49例） 术前 5.65±1.61 385.6±134.4 58.9±9.4 7.1±5.2
? 术后0 d 7.81±2.63 186.9±157.6 80.4±9.2 7.6±6.2
? 术后1 d 11.15±3.38 445.8±189.6 86.4±5.3 93.7±36.2
? 术后3 d 9.57±3.56 408.5±190.1 81.4±6.1 140.5±62.1
? 术后7 d 8.24±3.05 409.6±124.6 71.4±8.5 57.6±34.2
开腹组（49例） 术前 5.72±1.52 401.3±167.8 59.7±9.3 7.2±5.1
? 术后0 d 7.79±2.49 243.6±174.9 81.1±9.3 8.1±7.3
? 术后1 d 11.63±3.46 512.5±194.3 87.3±6.1 108.9±46.5
? 术后3 d 9.46±3.47 423.5±128.9 82.2±6.2 184.3±70.3
? 术后7 d 8.31±2.96 411.8±134.2 72.1±8.7 62.4±38.7
t值a ? 1.687, 1.699, 1.643, 1.823, 1.792 1.013, 1.853, 1.571, 1.237, 1.228 1.121, 1.764, 1.957, 1.355, 1.823 1.012, 1.563, 2.379, 3.562, 1.783
P值a ? 0.468, 0.853, 0.716, 0.853, 0.998 0.683, 0.012, 0.022, 0.721, 0.885 0.866, 0.847, 0.923, 0.647, 0.876 0.934, 0.881, 0.023, 0.014, 0.889
表4 两种手术方式对结肠癌患者腹腔微转移指标的影响（μg/L,±s, t检验）
组别 癌胚抗原（CEA） 多巴脱羧酶（DDC）
手术开始 手术结束 手术开始 手术结束
腹腔镜组（49例） 226.8±126.7 1 495.8±657.4 7.9±4.65 121.5±48.6
开腹组（49例） 239.7±127.8 2 873.8±1 752.1 6.9±5.24 165.7±58.7
t值 1.458 2.861 1.024 2.534
P值 0.446 0.011 0.573 0.012
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