The Impact of Laparoscopic and Open Total Mesocolon Resection on Platelet Activation，Incidence of Complications，and Tumor Recurrence in Colon Cancer Patients
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摘要:
目的 探讨不同方式行完全结肠系膜切除术（complete mesocolic excision，CME）对结肠癌患者血小板活化、并发症发生率及肿瘤复发的影响。 方法 选取2020年1月至2022年1月昆明市第二人民医院80例结肠癌患者，按照治疗方案分为2组，各40例。对照组行开腹CME，观察组行腹腔镜CME。比较2组围术期情况、淋巴结清扫数量、术后并发症发生率、手术前后血清炎性指标：白细胞介素-6（IL-6）、C反应蛋白（CRP）；血小板活化指标：血小板-中性粒细胞聚集体（PNA）、血小板-淋巴细胞聚集体（PlyA）、血小板-单核细胞聚集体（PMA）、血小板-白细胞聚集体（PLA）及肿瘤复发情况。 结果 观察组术中出血量与术后引流量少于对照组，肛门排便时间、肛门排气时间及住院天数均短于对照组（P < 0.05）；观察组Ⅲ期、阳性及左右半结肠淋巴结清扫数量高于对照组，术后总并发症发生率较对照组低（P < 0.05）；观察组术后1 d血清IL-6、CRP均低于对照组（P < 0.05）；观察组术后1 d PLA、PlyA、PMA、PNA均低于对照组（P < 0.05）；观察组术后1a复发率低于对照组，无复发生存时间长于对照组（P < 0.05）。 结论 腹腔镜CME治疗结肠癌手术时间与开腹CME相当，但能减少术中出血，降低炎性反应程度，改善血小板活化状态，促进病情恢复，同时提高淋巴结清除效果，降低复发风险，延长生存期，减少并发症发生。 Abstract:Objective To investigate the effects of different methods of complete mesocolectomy （CME） on the platelet activation, complication rate and tumor recurrence in patients with colon cancer. Methods 80 patients with colon cancer in The 2nd People's Hospital of Kunming from January 2020 to January 2022 were selected and divided into 2 groups according to the treatment plan, with 40 cases in each group. The control group underwent open CME, and the observation group underwent laparoscopic CME to compare the perioperative situation, number of lymph node dissection, incidence of postoperative complications, as well as serum inflammatory [interleukin-6 （IL-6）, C-reactive protein （CRP）] and platelet activation indicators [platelet neutrophil aggregates （PNA）, platelet lymphocytic aggregation （PlyA）, platelet leukocyte aggregation （PMA）, platelet leukocyte aggregates （PLA）] before and after surgery and the tumor recurrence rate between the two groups. Results The intraoperative blood loss and postoperative drainage volume in the observation group were less than those in the control group, and the anal defecation time, anal exhaust time and hospitalization days were shorter than those in the control group （P < 0.05）. The number of stage III, positive and left and right hemicolic lymph nodes dissection in the observation group was higher than that in the control group, and the incidence of postoperative complications was lower than that in the control group （P < 0.05）. Serum IL-6 and CRP in the observation group were lower than those in the control group 1 day after the operation （P < 0.05）. PLA, PlyA, PMA and PNA in the observation group were lower than those in the control group 1 day after the operation （P < 0.05）. The one-year recurrence rate of the observation group was lower than that of the control group, and the survival time without recurrence was longer than that of the control group （P < 0.05）. Conclusion The operative time of laparoscopic CME for colon cancer is similar to that of open CME, but it can reduce the intraoperative bleeding, reduce the inflammatory response, improve the platelet activation, promote the disease recovery, improve the lymph node clearance, reduce the recurrence risk, prolong survival, and reduce complications. -
Key words:
- Colon cancer /
- Complete mesocolectomy /
- Open surgery /
- Laparoscopy /
- Lymph node dissection /
- Platelet activation /
- Recrudescence
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表 1 2组基线资料比较[（
$\bar x \pm s $ ）/n（%）]Table 1. Comparison of baseline data between two groups [（
$\bar x \pm s $ ）/n（%）]基线资料 观察组（n = 40） 对照组（n = 40） χ2/t P 年龄（岁） 45～68
（56.55 ± 5.62）47～70
（57.14 ± 5.15）0.553 0.582 性别 0.201 0.654 男 22（55.00） 20（50.00） 女 18（45.00） 20（50.00） 体重指数（kg/m2） 19～26
（22.81 ± 1.54）20～27
（23.12 ± 1.56）1.010 0.315 位置 0.052 0.820 高位 17（42.50） 16（40.00） 低位 23（57.50） 24（60.00） AJCC分期 0.818 0.366 Ⅱ期 25（62.50） 21（52.50） Ⅲ期 15（37.50） 19（47.50） 合并疾病 高血压 7（17.50） 8（20.00） 0.082 0.775 糖尿病 7（17.50） 5（12.50） 0.392 0.531 冠心病 6（15.00） 8（20.00） 0.346 0.556 
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表 2 2组手术相关指标比较（
$\bar x \pm s $ ）Table 2. Comparison of surgery-related indexes between the two groups （
$\bar x \pm s $ ）组别 n 手术时长（min） 术中出血量（mL） 术后引流量（mL） 肛门排气时间（d） 肛门排便时间（d） 住院天数（d） 观察组 40 138.21 ± 35.26 91.02 ± 23.47 24.92 ± 6.73 2.62 ± 1.14 4.26 ± 1.12 10.58 ± 2.84 对照组 40 140.34 ± 34.13 123.37 ± 30.58 30.56 ± 7.23 3.45 ± 1.26 5.42 ± 1.31 15.26 ± 3.12 t 0.275 5.308 3.611 3.089 4.257 7.016 P 0.784 < 0.001* 0.001* 0.003* < 0.001* < 0.001* *P < 0.05。
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表 3 2组淋巴结清扫情况比较[（
$\bar x \pm s $ ），个]Table 3. Comparison of lymph node dissection between the two groups [（
$\bar x \pm s $ ），each]组别 n 淋巴结清扫数量 阳性淋巴结清
扫数量左半结肠淋巴结清
扫数量右半结肠淋巴结清
扫数量Ⅰ期 Ⅱ期 Ⅲ期 观察组 40 17.42 ± 1.94 17.52 ± 2.13 25.74 ± 1.73 22.78 ± 2.84 18.92 ± 2.83 24.12 ± 3.06 对照组 40 16.82 ± 1.76 16.94 ± 2.30 17.82 ± 2.47 11.52 ± 3.27 16.52 ± 2.45 18.72 ± 2.77 t 1.449 1.170 16.611 16.443 4.055 8.274 P 0.151 0.246 < 0.001* < 0.001* < 0.001* < 0.001* *P < 0.05。
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表 4 2组术后并发症发生率比较 [n（%）]
Table 4. Comparison of postoperative complication rates between the two groups [n（%）]
组别 n 切口感染 吻合口瘘 淋巴瘘 不完全性肠梗阻 下肢深静脉血栓 总发生率 观察组 40 1（2.50） 1（2.50） 0（0.00） 1（2.50） 0（0.00） 3（7.50） 对照组 40 4（10.00） 3（7.50） 1（2.50） 2（5.00） 1（2.50） 11（27.50） t 5.541 P 0.019* *P < 0.05。
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表 5 2组血清炎性指标比较（
$\bar x \pm s $ ）Table 5. Comparison of serum inflammatory indexes between the two groups （
$\bar x \pm s $ ）组别 n IL-6（μg/L） CRP（mg/L） 术前 术后1 d 术后5 d 术前 术后1 d 术后5 d 观察组 40 45.83 ± 10.25 72.88 ± 21.33#* 18.57 ± 4.61#* 35.49 ± 12.37 65.41 ± 20.17#* 8.63 ± 3.41#* 对照组 40 44.89 ± 12.37 90.54 ± 25.47 20.04 ± 5.74 34.98 ± 10.25 84.94 ± 20.45 9.87 ± 4.02 t F组间 = 4.897，F时间 = 42.668，F交互 = 10.772 F组间 = 5.776，F时间 = 35.661，F交互 = 9.159 P P组间 = 0.039△，P时间 < 0.001△，P交互 < 0.001△ P组间 = 0.024△，P时间 < 0.001△，P交互 < 0.001△ 与术前比较，#P < 0.05；与对照组比较，*P < 0.05；△P < 0.05。
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表 6 2组血小板活化指标比较[（
$\bar x \pm s $ ），%]（1）Table 6. Comparison of platelet activation indexes between the two groups [（
$\bar x \pm s $ ），%]（1）组别 n PLA PlyA 术前 术后1 d 术后5 d 术前 术后1 d 术后5 d 观察组 40 23.64 ± 2.53 28.85 ± 5.06# 15.14 ± 3.25# 28.47 ± 2.74 34.06 ± 5.69# 17.98 ± 3.02# 对照组 40 23.12 ± 2.58 35.69 ± 5.74# 15.74 ± 4.06# 28.63 ± 3.02 42.41 ± 6.13# 18.37 ± 3.27# t F组间 = 7.028，F时间 = 28.731，F交互 = 9.986 F组间 = 6.973，F时间 = 30.284，F交互 = 10.128 P P组间 < 0.001△，P时间 < 0.001△，P交互 < 0.001△ P组间 = 0.001△，P时间 < 0.001△，P交互 < 0.001△ 与术前比较，#P < 0.05；△P < 0.05。
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表 6 2组血小板活化指标比较[（
$\bar x \pm s $ ），%]（2）Table 6. Comparison of platelet activation indexes between the two groups [ （
$ \bar{x} $ ±s），%]（2）组别 n PMA PNA 术前 术后1 d 术后5 d 术前 术后1 d 术后5 d 观察组 40 29.83 ± 3.45 35.69 ± 7.41#* 20.26 ± 4.12#* 25.56 ± 4.42 34.27 ± 5.94#* 16.79 ± 5.17#* 对照组 40 29.96 ± 3.82 44.87 ± 9.25 20.78 ± 4.58 25.74 ± 4.56 41.88 ± 6.23 17.04 ± 5.84 t F组间 = 7.229，F时间 = 31.583，F交互 = 12.478 F组间 = 8.127，F时间 = 29.546，F交互 = 11.045 P P组间 < 0.001△，P时间 < 0.001△，P交互 < 0.001△ P组间 < 0.001△，P时间 < 0.001△，P交互 < 0.001△ 与术前比较，#P < 0.05；与对照组比较，*P < 0.05；△P < 0.05。
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