腹腔镜结肠癌根治术治疗老年局部进展期结肠癌的疗效和安全性及对患者免疫功能的影响

目的:比较分析腹腔镜和开腹结肠癌根治术治疗老年局部进展期结肠癌的临床疗效和安全性及对患者免疫功能的影响。方法:根据随机数字表法,将64例老年局部进展期结肠癌患者随机分为腹腔镜组和开腹组,每组各32例,分别接受腹腔镜、开腹结肠癌根治术治疗。比较两组手术相关指标、手术前后免疫功能变化、术后近远期并发症的发生情况及预后。结果:与开腹组比较,腹腔镜组患者手术时间明显延长,而术中出血量、胃肠功能恢复时间则明显缩短(P<0.05)。两组淋巴结清扫数比较差异无统计学意义(P>0.05)。术后3个月,腹腔镜组CD4+、CD4+/CD8+比值均明显高于开腹组(P<0.05),且与术前比较差异均无统计学意义(P>0.05)。与开腹组比较,腹腔镜组患者术后切口感染的发生率明显降低(P<0.05),两组其他近期并发症如吻合口瘘、吻合口出血,远期并发症如黏连性肠梗阻、切口疝的发生率比较差异均无统计学意义(P>0.05)。腹腔镜组与开腹组术后2年的局部复发率、1年和2年生存率比较差异均无统计学意义(P>0.05)。结论:腹腔镜手术和开腹手术治疗老年局部进展期结肠癌患者的临床疗效和预后相当,但腹腔镜手术对患者的免疫功能影响更小,且安全性更高。

Efficacy and Safety of Laparoscopic Radical Resection of Colon Cancer in the Treatment of Elderly Patients with Locally Advanced Colon Cancer and Its Effect on the Immune Function

ABSTRACT Objective: To analyze the effects and safety of laparoscopy and laparoscopic radical resection of colon cancer, and influence on immune function in elderly patients with locally advanced colon cancer. Methods: According to the random number table, 64 elderly patients with locally advanced colon cancer were divided into two groups. Laparoscopic radical resection(laparoscope group,n=32) and open radical resection(open group, n=32) were used respectively. The operative indexes, changes of immune function before and after operation, incidence of postoperative complications and prognosis were compared between two groups. Results: Compared with open group, the operation time in laparoscope group was significantly increased, while the intraoperative blood loss and recovery time of gastrointestinal function were significantly reduced (P<0.05). No significant difference was found in the number of lymph node dissection between the two groups(P>0.05). Three months after surgery, the CD4+ and CD4+/CD8+ ratios in laparoscope group were significantly higher than those in control group, with no statistically significant difference from the preoperative level(P>0.05), and all the indicators of immune function were significantly higher than those in open group (P<0.05). Compared with open group, the incidence of postoperative incision infection was significantly reduced in laparoscope group (P<0.05), while the incidence of other short-term complications such as anastomotic fistula and anastomotic bleeding, and long-term complications such as adhesive intestinal obstruction and incisional hernia were not statistically difference between two groups(P>0.05). The local recurrence rate, 1-year survival rate and 2-year survival rate of laparoscope group and open group were not statistically different(P>0.05). Conclusion: The clinical efficacy and prognosis of laparoscopic surgery and laparotomy in the treatment of elderly patients with locally advanced colon cancer are similar, but laparoscopic surgery has less effect on the immune function and higher safety.