2021 年第 9 期 第 16 卷

腹腔镜与开腹式结直肠癌根治术对细胞免疫和氧化应激及能量代谢的影响

Effects of laparoscopic and open radical resection of colorectal cancer on cellular immunity, oxidative stress and energy metabolism

作者：黄宝玉1田景中1李光云1许建国1朱建伟2

英文作者：Huang Baoyu1 Tian Jingzhong1 Li Guangyun1 Xu Jianguo1 Zhu Jianwei2

单位：1安徽省亳州市人民医院胃肠外科236800；2南通大学附属医院胃肠外科226001

英文单位：1Department of Gastrointestinal Surgery the People′s Hospital of Bozhou Anhui Province Bozhou 236800 China; 2Department of Gastrointestinal Surgery Affiliated Hospital of Nantong University Nantong 226001 China

关键词：结直肠癌；腹腔镜结直肠癌根治术；细胞免疫；氧化应激；能量代谢

英文关键词：Colorectalcancer;Laparoscopicradicalresectionofcolorectalcancer;Cellularimmunity;Oxidativestress;Energymetabolism

• 摘要：

• 目的 探讨腹腔镜与开腹式结直肠癌根治术对患者术后细胞免疫、氧化应激及能量代谢的影响。方法 选取2017年1月至2020年9月安徽省亳州市人民医院收治的120例结直肠癌患者作为研究对象，根据随机数字表法分为腹腔镜组和开腹组，各60例。腹腔镜组患者行腹腔镜结直肠癌根治术，开腹组患者行开腹式结直肠癌根治术。比较2组手术相关指标、临床疗效。术前、术后3 d检测细胞免疫、氧化应激及能量代谢指标水平。记录术后并发症发生情况。结果 腹腔镜组术中出血量少于开腹组，术后排气时间、术后固体进食时间、术后住院时间均短于开腹组，差异均有统计学意义（均P＜0.05）。2组临床疗效比较差异无统计学意义（P＞0.05）。2组术后CD+3、CD+4、CD+8、超氧化物歧化酶水平均低于术前，但腹腔镜组均高于开腹组，丙二醛水平均高于术前，但腹腔镜组低于开腹组，差异均有统计学意义（均P＜0.05）。2组术后前白蛋白、白蛋白、转铁蛋白、视黄醇结合蛋白水平均较术前明显降低，但腹腔镜组均明显高于开腹组［（235±21）mg/L比（212±25）mg/L、（35±3）g/L比（31±4）g/L、（2.98±0.21）g/L比（2.23±0.25）g/L、（18.0±2.5）mg/L比（14.6±2.4）mg/L］（均P＜0.05）。腹腔镜组术后并发症发生率低于开腹组，差异有统计学意义（P＜0.001）。结论 腹腔镜与开腹式结直肠癌根治术均具有较好的近期临床疗效，但前者在术后恢复方面更具优势，可能与对机体细胞免疫、氧化应激及能量代谢影响较小等因素有关。

• Objective To investigate the effects of laparoscopic and open radical resection of colorectal cancer on cellular immunity, oxidative stress and energy metabolism after operation. Methods From January 2017 to September 2020, 120 patients with colorectal cancer admitted to the People′s Hospital of Bozhou, Anhui Province were enrolled. They were randomly divided into laparoscopic group and open group, with 60 cases in each group. Patients in laparoscopic group were treated with laparoscopic radical resection of colorectal cancer and patients in open group were treated with open radical resection of colorectal cancer. The operation related indexes, clinical effect were compared between the two groups. The cellular immunity, oxidative stress and energy metabolism indexes levels of the two groups before and 3 d after operation were detected and complications after operation were recorded. Results The intraoperative blood loss of the laparoscopic group was lower than that of the open group, and the postoperative exhaust time, postoperative solid food intake time, and postoperative length of stay of the laparoscopic group were shorter those of the open group (all P<0.05). There was no significant difference in clinical effect between the two groups (P>0.05). After operation, CD+3, CD+4, CD+8 and superoxide dismutase levels of the two groups were lower than those before operation, but those of the laparoscopic group were higher than those of the open group; the malondialdehyde level of the two groups were higher than that before operation, but that of the laparoscopic group was lower than that of the open group (all P<0.05). After operation, prealbumin, albumin, transferrin and retinol binding protein of the two groups were lower than those before operation, but those of the laparoscopic group were higher than those of the open group［（235±21）mg/L vs （212±25）mg/L,（35±3）g/L vs （31±4）g/L,（2.98±0.21）g/L vs （2.23±0.25）g/L,（18.0±2.5）mg/L vs （14.6±2.4）mg/L］(all P<0.05). The incidence of postoperative complications of the laparoscopic group was lower than that of the open group (P<0.001). Conclusion Both laparoscopic and open radical resection of colorectal cancer have good short-term clinical effect, but the former has more advantages in postoperative recovery, which may be related to the less impact on cellular immunity, oxidative stress and energy metabolism.