腹腔镜结直肠癌手术对患者高凝状态 及免疫功能的影响

Effect of laparoscopic surgery on hypercoagulable state and immune function in patients with colorectal cancer

摘要:

目的 研究腹腔镜和开腹手术对结直肠癌患者高凝状态及免疫功能的影响。方法 收集2013 年2 月- 2015 年8 月该院行结直肠癌手术的121 例患者作为研究对象。其中行腹腔镜下手术73 例（腹腔镜组），行开 腹手术48 例（开腹组）；比较两组手术前后高凝状态指标D- 二聚体（D-D）、凝血酶原片段1+2（F1+2）、蛋 白C（Pro-C）和细胞免疫指标CD3+、CD4+ 及CD8+。结果 与同组术前比较，术后开腹组CD3+ 呈下降趋势 （t =-7.419，P =0.000），而腹腔镜组CD3+ 无变化（t =-0.218，P =0.901）；与开腹组术后比较，腹腔镜组术后 D-D 值呈升高趋势（t =2.312，P =0.018），Pro-C 值无变化（t =0.180，P =0.941）、F1+2 与CD4+ 值降低幅度较 小（t =3.827 和5.930，P =0.000 和0.008）、CD8+ 值升高幅度缓慢（t =-9.094，P =0.000）。结论 腹腔镜手术 是结直肠癌治疗的有效手术方式，但容易造成血液高凝状态，围手术期间应采取必要的预防措施。

Abstract:

Objective To study the effect of laparoscopic surgery and open operation on hypercoagulable state and immune function in patients with colorectal cancer. Methods The clinical data of 121 colorectal cancer patients who underwent Colorectal cancer surgery in our Hospital from Feburay 2013 to August 2015 were collected. There were 73 cases with laparoscopic surgery, and 48 cases with open operation. The indicators of hypercoagulable state (D-dimer, Prothrombin Fragment 1 and 2, Protein C) and immune function (CD3+, CD4+, CD8+) were compared before and after surgery between two groups. Results Compared with the preoperative period, the level of CD3+ was decreased postoperatively in the open operation group (t = -7.419, P = 0.000), while there was no such significant change in the laparoscopic group (t = -0.218, P = 0.901). Compared with the open operation group, the increase of D-D was significantly higher after surgery in the laparoscopic group, but the Pro-c value was not significantly changed; F1+2 and CD4+ decreased slightly and CD8+ increased slowly in the laparoscopy group. Conclusions Laparoscopic surgery is an effective method for colorectal cancer treatment, but it is easy to cause hypercoagulable state of blood. Necessary preventive measures should be taken during the perioperative period.