庄佳娥?庄柏润?包冕?吴库生

[摘要] 目的 观察腹腔镜与开放術治疗直肠癌术后感染的致病菌分布情况以及对干扰素、白介素体内水平的影响。 方法 自广东省惠州市中心人民医院2014年1月～2015年12月间采取手术治疗的直肠癌患者中，择取43例腹腔镜下手术治疗的患者纳入腹腔镜组，另择取43例开放术治疗的患者纳入开放组中，统计两组术后感染的发生率，检测两组术后感染患者的致病菌以及干扰素-γ（IFN-γ）、白介素-2（IL-2）、白介素-10（IL-10）的水平并进行统计学分析。 结果 腹腔镜组术后感染发生率为6.98%，开放组术后感染发生率为23.26%；两组感染率差别有统计学意义并且腹腔镜组低于开放组（P<0.05）。开放组共检出致病菌株24株，其中革兰阴性菌分布占比为66.67%，革兰阳性菌占比为33.33%；腹腔镜组共检出致病菌株11株，其中革兰阴性菌分布占比为63.64%，革兰阳性菌占比为36.36%；腹腔镜组检出致病菌株数显著低于开放组（P<0.05）。术后腹腔镜组IL-2、IL-10、IFN-γ的水平均优于开放组（P<0.05）。 结论 腹腔镜手术治疗直肠癌患者具有降低术后致病菌感染概率的优势，对于自身免疫功能的损伤较轻，有利于术后尽早恢复，与传统开放术相比优势更加明显，值得在直肠癌手术治疗中推广应用。

[关键词] 直肠癌；腹腔镜手术；开放手术；术后感染致病菌

[中图分类号] R735.37 [文献标识码] A [文章编号] 2095-0616（2017）14-11-04

Distributions of pathogenic bacteria and levels of interferon and interleukin in rectal cancer patients after laparoscopic surgery or open surgery

ZHUANG Jia'e1 ZHUANG Bairun2 BAO Mian1 WU Kusheng1

1.Department of Preventive Medicine，Shantou University Medical College，Shantou 515041，China；2.Department of Gastrointestinal Surgery，Huizhou Central People's Hospital，Huizhou 516001，China

[Abstract] Objective To investigate the distribution of pathogenic bacteria and its influence on the level of interferon and interleukin in patients with rectal cancer after laparoscopic surgery or open surgery. Methods The patients with rectal cancer going through surgery treatment from Huizhou Central Hospital From January 2014 to December 2015 were recruited，in which 43 patients undergoing laparoscopic surgery were included into the laparoscopic group，and other 43 patients undergoing open surgery were selected into the open group.The incidence of postoperative infection in the two groups was calculated and levels of pathogenic bacteria，gamma interferon（IFN-γ），interleukin-2（IL-2） and interleukin-10（IL-10） were analyzed. Results The incidence of postoperative infection in laparoscopic group was 6.98%，while the incidence of postoperative infection in the open group was 23.26%.There was significant difference in the two groups and the incidence of postoperative infection on laparoscopic group was lower than the open group（P<0.05）.24 pathogenic strains were detected in the open group.The proportion of gram-negative bacteria was 66.67%，while gram-positive bacteria accounted for 33.33%.11 pathogenic strains were detected in the laparoscopic group，in which gram-negative bacteria accounted for 63.64% and gram-positive bacteria accounted for 36.36%.The detected number of pathogenic bacteria in the laparoscopic group was significantly lower than that in the open group（P<0.05）.The level of IL-2，IL-10 and IFN-γ in the laparoscopic group were significantly higher than those in the open group （P<0.05）. Conclusion Comparing with the traditional open surgery，laparoscopic surgery for patients with rectal cancer has the advantage of reducing the incidence of postoperative pathogens infection.Laparoscopic surgery has relatively lower damage for autoimmune function，which is good for recovery.It is worth to be popularized and applied for the treatment of rectal cancer surgery.

[Key words] Rectal cancer；Laparoscopic surgery；Open surgery；Postoperative infection pathogens

随着我国人民收入水平的大幅提高，人们的生活条件与饮食结构均发生了重大的转变，使得直肠癌的发生率呈现出逐年攀升的趋势，给患者的生命健康造成了重大的威胁。直肠癌是消化系统中一种十分多见的恶性肿瘤[1-3]。我国直肠癌的发病率位居恶性肿瘤发病率的第三位。直肠癌好发于中老年人群当中，绝大部分患者的发病年龄均高于40岁，直肠癌患者中30岁以下的患者仅有15%左右[4-6]。直肠癌的男女发病比例约为2：1。目前直肠癌的治疗主要是以手术治疗为主，术后创口感染是手术治疗的一项最为常见的术后并发症。而直肠癌手术由于生理解剖位置的特殊性，致使术后感染的发生率较高。……