自然腔道取出标本手术对直肠癌患者术后康复及免疫功能的影响分析

目的:探讨经自然腔道取出标本手术(NOSES)对直肠癌患者术后康复及免疫功能的影响。方法:回顾性分析2015年2月—2016年12月收治的98例直肠癌患者的临床资料,其中49例接受NOSES直肠癌根治术(观察组),49例采用传统腹腔镜直肠癌根治术(对照组),分析两组患者的相关临床指标以及手术前后应激因子与免疫功能指标的变化。结果:观察组患者术后排气时间短于对照组(2.62 d vs. 3.31 d,P0.05);手术时间、术中出血量、淋巴结清扫数目与对照组无统计学差异(均P0.05)。两组患者术前E-选择素、内皮素(ET)、可溶性血管细胞黏附分子1(sVCAM-1)、基质金属蛋白酶9(MMP-9)、免疫球蛋白水平均无统计学差异(均P0.05),观察组患者术后E-选择素、ET、sVCAM-1、MMP-9水平明显低于对照组,而免疫球蛋白水平明显高于对照组(均P0.05)。观察组患者并发症发生率低于对照组(8.16%vs. 18.37%),但差异无统计学意义(P0.05)。结论:NOSES直肠癌根治术可达到与传统手术相同的肿瘤学根治目的,且可减少应激因子的表达,对机体免疫功能影响较小,安全性高,患者恢复快。

Analysis of impact of natural orifice specimen extraction surgery on postoperative recovery and immune function in patients with rectal cancer

Objective: To investigate the influences of natural orifice specimen extraction surgery (NOSES) on postoperative recovery and immune function in patients with rectal cancer.     Methods: The clinical data of 98 patients with rectal cancer treated from February 2015 to December 2016 were retrospectively analyzed. Of the patients, 49 cases underwent radical rectal cancer resection with the NOSE approach (observation group), and the other 49 cases underwent conventional laparoscopic radical rectal cancer resection (control group). The main clinical variables and the pre- and postoperative levels of stress factors and immune function parameters of the two groups of patients were analyzed.  Results: In observation group compared with control group, the time to postoperative gas passage was significantly reduced (2.62 d vs. 3.31 d, P<0.05), while the operative time, intraoperative blood loss and number of resected lymph nodes showed no significant differences (all P>0.05). There were no significant differences in the levels of E-selectin, endothelin (ET), soluble vascular cell adhesion molecule 1 (sVCAM-1), matrix metalloproteinases 9 (MMP-9) and immunoglobulins between the two groups before operation (all P>0.05), but the postoperative levels of E-selectin, ET, sVCAM-1 and MMP-9 were significantly lower and the postoperative levels of immunoglobulins were significantly higher in observation group than those in control group (all P<0.05). the incidence of complications in observation group was lower than that in control group (8.16% vs. 18.37%), but it did not reach a statistical significance (P>0.05). Conclusion: NOSE radical rectal cancer resection can achieve the equivalent oncologic outcomes of the traditional procedures, and it can also reduce the expressions of stress factors, exert less impact on immune function, and accelerate the recovery of the patients.