| Objective To explore clinical effect between laparoscopy and laparotomy in the treatment of colon cancer.And the changes of anti-and pro-inflammation system after surgery in colon cancer patients.Methods A retrospective analysis of 231 cases of colon cancer were performed between June 2012 to June 2016 in Affiliated Changshu Hospital of Suzhou University(Changshu First People's Hospital).One-hundred and twenty-one patients were conducted with complete mesorectal excision(CME)by laparoscopic.One-hundred and ten patients were conducted with CME by laparotomy.It was compared that the data between two groups of patients(age,gender,chronic diseases such as hypertension disease,history of smoking,drinking,BMI(Body Mass Index,BMI),the American Society of Anesthesiologists(American Society of Anesthesiologists,ASA)surgery classification,etc.),degree of tumor differentiation(including low differentiation/undifferentiated),in the differentiation and high differentiation,TNM stage,tumor site,including the right colon,left half colon and sigmoid colon),operation time,intraoperative blood loss,number of lymph node cleaning,tumor diameter,postoperative bed time,anus exhaust time,eating semifluid time,flow rate,the average length of hospital stay and postoperative hospitalization cost,etc.We used enzyme-linked immunosorbent assay to evaluate antiand pro-inflammation system at three time points(before surgery,1 day and 3 day after surgery).Tumor necrosis factor alpha(TNF alpha)and interleukin-6(IL-6)were selected as pro-inflammation factors.Transform growth factor beta(TGF-beta)and Il-4 were selected as anti-inflammation factors.All data were statistically analyzed by SPSS 22.0 statistical software.The measurement data of normal distribution is expressed by means of mean plus or minus standard deviation.The measurement data is in normal distribution and homogeneity of variance,and t-test or single factor analysis of variance is used,and one-way anova is used for the comparison between multiple groups.Compared with the non-normal distribution or variance,the mann-whitney U test was used for comparison between the two groups,and kruskal-wallis H test was used in multiple groups,and the binary data was analyzed by Fisher's exact test.It is statistically significant when P is less than or equal to 0.05.Results(1)In comparison of laparotomy group,the levels of age,gender,hypertension chronic conditions such as distribution,history of smoking,drinking,BMI and ASA in laparoscopic group showed no significant statistical difference(P>0.05).(2)In comparison of laparotomy group,the levels of differentiation degree of tumor,TNM stage distribution and tumor site distribution in laparoscopic group showed no significant statistical difference(P>0.05).(3)In comparison of laparotomy group,the levels of intraoperative blood loss(183.82±79.11 ml vs.127.14±69.54 ml,t=4.062,P<0.001),postoperative bed time(3.13±1.04 d vs.2.21±1.76 d,t= 3.394,P<0.001),anal exhaust time(4.37±0.81 d vs.3.50±days,t=4.615,P<0.001),eating semifluid time(5.57±0.97 d vs.4.75±1.51 d,t=3.449,P<0.001),and levels of drainage(298.44±121.44 ml vs.192.45±89.66 ml,t=5.301,P<0.001)in the laparoscopic showed more better.While other index did not see clearly obvious statistical difference(P>0.05).(4)In comparison of laparotomy group,the average length of hospital stay and in patients with laparoscopic group was obviously lower than laparotomy group of patients(9.75±4.11 d vs.12.47±4.40 d,t=3.410,P<0.001)and hospital costs(45087.74±5613.12 yuan vs.47597.55±3877.65 yuan,t=2.777,P=0.004)in laparoscopic group were significantly lower.(5)In comparison of laparotomy group,Laparotomy group of postoperative complications,a total of 31 cases(28.2%),significantly higher than the postoperative complications in patients with laparoscopic group 18 cases(14.9%)(X2=6.104,P=6.104),but between single complications had no statistical significance(P>0.05).(6)Group of preoperative patients with postoperative body cavity lens group and laparotomy anti-inflammatory and proinflammatory system evaluation,proinflammatory factor,is visible in the group and TNF alpha concentration in patients with 3 days after laparoscopic group were down more obvious compared with postoperative 1 day(laparoscopic group: 132.22±55.43 pg/ml vs.178.54±39.39 pg/ml,t = 5.142,P < 0.001).In both groups,serum il-6 concentrations were higher in 1 day after surgery(open group: 464.62±115.87 pg/ml vs.622.22±132.29pg/ml,t=6.787,P<0.001).Laparoscopy group: 454.72±78.23 pg/ml vs.554.22 pg/ml,t=6.340,P<0.001).In the third day after surgery,the concentration of TNF in the laparoscope group was significantly lower than that in the first day after surgery(laparoscopic group: 554.22±89.82 pg/ml vs.500.54±55.42 pg/ml,t=3.842,P<0.001).In comparison,the serum TNF and il-6 were higher than those in the laparoscope group at 1 day after the surgery,and the expression of il-6 was more obvious(TNF: 188.56±49.33 pg/ml vs.178.54 ±39.39pg/ml,t=1.198,P=0.119).Il-6:6 22.22 pg/ml vs.554.22 pg/ml,t=3.212,P=0.001).3 days after surgery,serum TNF and il-6 were significantly higher than those in the laparoscope group(TNF: 180.11±62.44 pg/ml vs.132.22±55.43pg/ml,t=4.330,P<0.001).Il-6:6,00.51,101.55pg/ml vs.500.54 pg /ml,t=6.502,P<0.001).In terms of anti-inflammatory factors,the serum TGF levels of the two groups were significantly lower in the two groups after surgery than before surgery(open group: 37.33±11.43pg/ml vs.19.25 pg/ml),t=8.937,P<0.001;Laparoscopy group: 40.54±9.24pg/ml vs.30.52±15.54pg/ml,t=7.035,P<0.001).In the third day after surgery,the TGF levels of both groups were significantly higher than that in the first day after surgery(open abdominal group: 26.44±9.22 pg/ml vs.19.25±10.13 pg/ml,t=3.962,P<0.001).Laparoscopy group: 45.22±14.92 pg/ml vs.30.52±15.54pg/ml,t=6.982,P<0.001).The serum il-4 concentration of the two groups was significantly lower in 1 day after surgery than before surgery(open group: 65.87±10.75pg/ml vs.48.92±12.95pg/ml,t=7.603,P<0.001;Laparoscopy group: 66.80±13.87pg/ml vs.50.65±15.76pg/ml,t=5.807,P<0.001).And after 3 days IL-4 levels in patients with laparoscopic group were compared with postoperative 1 day increased obviously(56.82±14.17 pg/ml vs.50.65±15.76 pg/ml,t = 2.197,P = 0.017),and IL-4 levels in patients with laparotomy group were compared with postoperative 1 day significantly lower(44.11±14.64 pg/ml vs.48.92±12.95 pg/ml,t = 1.857,P = 0.036).In the comparison between the groups,serum TGF was significantly lower than that in the laparoscope group at 1 day after surgery(TGF: 19.25±10.13pg/ml vs.30.52±15.54pg/ml,t=7.356,P<0.001).3 days after surgery,serum TGF and il-4 were significantly lower than those in the laparoscopic group(TGF: 26.44±9.22 pg/ml vs.45.22 pg/ml,t=8.084,P<0.001).Il-4:44.11±14.64pg/ml vs.56.82±14.17pg/ml,t=4.709,P<0.001).Conclusion(1)CME performed by Laparoscopic will further reduce the contents of intraoperative blood loss and postoperative flow,further decrease the time of postoperative bed time,anus exhaust time and eating semifluid,which shows better operability.(2)CME performed by Laparoscopic will further reduce mean hospital days and cost,which shows better cost pressure.(3)CME performed by Laparoscopic will further reduce total complication rate,which shows better security.(4)CME performed by Laparoscopic will further reduce the activity to pro-inflammation system and inhibition to anti-inflammation system by surgery. |
PDF Full Text Request