| ObjectiveTo investigate the surgical treatment of colorectal cancer for the CD 133 molecule expression and clinical significance,indicating that laparoscopic surgery for colorectal cancer minimally invasive and safety analysis of laparoscopic surgery for the treatment of colorectal cancer Inflammatory Factors.MethodsIn September 2013 to 2015 September choice of Shenzhen City Hospital of traditional Chinese medicine in patients with colorectal cancer in 120 cases as the object of study,the inclusion criteria:age is more than or equal to 18 years old,suitable for surgery;have different degrees of change in bowel habits,abdominal pain,bloating,gas,preoperative without put chemotherapy neoadjuvant therapy is expected survival>3 months;there are certain culture can be understood and responded to the questionnaire;scheme was approved by the ethics committee,Shenzhen City Hospital of traditional Chinese medicine,subjects signed the informed consent.Exclusion criteria:tumor metastasis and invasion of adjacent tissues and organs;previous history of abdominal surgery,shock,obstruction,jaundice,intestinal obstruction,hemorrhage;preoperative long-term use of antibiotics;serious complications(such as pancreatitis,burns,trauma),persons with mental illness obstacle.According to the principle of random draw was divided into the experimental group and the control group of 60 cases,the two groups of patients were not statistically significant difference(P<0.05),the group has comparability.Experimental group treated with laparoscopic surgery,general anesthesia with endotracheal intubation,take the supine position or lithotomy position,operation according to the requirements of the surgical field moderate adjustment of the position.Routine establishment of pneumoperitoneum pressure for 12-14mmHg and in the umbilical as the observation hole placement 12mm trocar,artificial pneumoperitoneum was established after implantation of 30 degrees of laparoscopic and abdominal exploration,and for right colon resection,resection of transverse colon,Zuo Ban colectomy,sigmoid colon resection operation.(1)right hemicolectomy:with the patient in the supine position,double lower limbs apart,was"one" word,midclavicular line above the umbilicus 4cm 6cm and umbilical respectively placed 5mm,sweet 12mmTroc,10ram placed on right midclavicular line flat umbilical trocar.Push the greater retina to the head side,exposing the mesenteric root.By using ultrasound knife after peritoneal along the direction of superior mesenteric vein cut open and expose the vein,in the superior mesenteric vein of the left side of the ligation of the cut off the right colic artery,arteria Colica;at the bottom of the horizontal part of duodenum revealed the ileocolic vein branches,in the superior mesenteric vein to the right side of the ligation cutting off right colic vein,colic vein;stripping pancreatic head surface connective tissue,dew right gastroepiploic vessels.The gastrocolic ligament to the right in the middle of the separation to the duodenal bulb were ligation right gastroepiploic artery and vein,to the appendix direction separation to the end of the ileal mesentery.Disconnection colon ligament of liver,colon liver area down free;from the inside out free back to the blind,the cecum and terminal ileum free;to extend the right abdomen to poke a hole to 5-6cm incision,in vitro and right hemicolectomy was performed,end to end anastomosis,closure of film hole after the gut also accept abdominal cavity and the incision was sutured.(2)the transverse colon resection:with the patient in the supine position,the left costal margin of anterior axillary line 2cm and left midclavicular line flat umbilical department were implanted 12mm,5mmTrocar in the right relative should position respectively placing 5mm,5mmmTrocar and operation station in the left.The posterior peritoneum was cut open and exposed in the direction of the superior mesenteric vein,and it was cut off from the middle of the colon by ligation of the middle of the colon.By the gastrocolic ligament central to the right,the disconnection hepatocolic ligament,along the gastroepiploic vessels arch lateral separation to bulb;along the gastric retinal vascular arch lateral to the left separation to the spleen door,free colon spleen,disconnection of gastrosplenic ligament;in the epigastrium median 5-6cm incision,free of transverse colon and the film is pulled out of the body and remove,end to end anastomosis and suture incision.(3)left hemicolectomy:Patients with herringbone,right midclavicular line umbilical umbilical and 4cm 6cm respectively placed 5mm,12mmTrocar,left mid clavicular line flat umbilical placed 12mm trocar.The inferior mesenteric artery was exposed to the distal end of the left colonic artery and the first branch of the sigmoid artery was isolated from the root.The inferior mesenteric vein was exposed to the inferior mesenteric vein and ligation of the inferior mesenteric vein.Free sigmoid colon left mesangial and free colon splenic flexure,free descending colon ligament,along the gastroepiploic vessels bow outward spleen very free;transection of left gastric colon ligament,disconnection of gastrosplenic ligament,left abdomen to poke a hole extending to the 5-6cm incision,free of left colon was pulled out of the body and resection,underwent transverse sigmoid end end anastomosis and the incision was sutured.(4)sigmoid resection:a herringbone,right midclavicular line and two anterior superior iliac spine connection node placement 12mmTrocar dominated hole operation,left and right midclavicular line flat umbilical points were placed 5mm 5mm trocar.Isolated mesenteric artery and in the root of ligation cutting cut mesenteric vein ligation in the same plane in and free to the left side of the abdominal wall,in the outside of the sigmoid mesocolon and the lateral abdominal wall separation,exposure of the left common iliac artery and in the rectum and sigmoid colon junction at bare tube,with straight line cutting closure device in breaking away from the rectum;left next abdomens to poke a hole extended to 4-5cm,entrusted to the intestine,the sigmoid colon and its mesentery pulled out of the body and resection and end to end anastomosis and suture incision.In the control group,the general anesthesia was used in the control group,and the operation was performed according to the traditional operation method.Observe and record the operation time,the amount of bleeding during operation,the days of postoperative indwelling catheter,the recovery time of bowel movement and the length of stay in hospital after operation.The occurrence of urinary retention,infection,intestinal obstruction and anastomotic leakage in the 1 groups were observed and recorded after two months.All patients in the preoperative and postoperative 1 months fasting blood samples were taken from peripheral venous blood 3 mL,injected into the heparin anticoagulant tube,to 2000 min-1 r 10 min centrifugation,the supernatant was examined.Serum interleukin(IL)-6 content was detected by radioimmunoassay,and serum IL-10 levels were measured by double antibody sandwich ELISA method.All patients in the preoperative and postoperative 1 month after of CD 133 expression detection,CD 133 molecule Rabbit anti human monoclonal antibody was purchased from Beijing Zhongshan Biotechnology Co.,Ltd.,experimental steps according to reagent instructions for(SP-9001 immunohisto chemical assay kit).Two groups of specimens by 10%formalin routinely fixed paraffin embedded and paraffin blocks were 4 m serial sections,eliminate the endogenous peroxidase activity,pressure cooker antigen repairing application,then add the CD133 molecule monoclonal antibodies against a and 4 DEG C placed at room temperature for about 30 minutes,the PBS continuous washing 3 times.Drop plus two anti,37 degrees Celsius for 10 minutes,PBS liquid washed again 3 times.DAB color for about 3-5 minutes,and hematoxylin staining,mounting observation.CD 133 positive expression mainly by presenting the brown yellow or brown granules in the cytoplasm and the number of positive cells more than 20%positive expression,experimental and positive control and negative control,negative control using PBS instead of the first antibody.At the same time to ensure the unity of the survey data,this study investigated the analysis content includes clinical pathological characteristics and prognosis of were analyzed,including age,sex,Dukes stage,differentiation,lymph node metastasis,body mass index,the location of disease,such as.All patients were followed up to date,the total survival time and median survival time of the two groups were recorded.All data in Excel input,select software SPSS 18.00 was used to analyze the data and measurement data were compared with test,rate test using chi square test,P<0.05 for differences have statistical significance.ResultsAll patients were successfully operated,the experimental group had no open service transit situation,but the experimental group blood loss,postoperative indwelling catheter for several days,bowel recovery time and hospital stay were significantly less than the control group(P<0.05),compare the operation time was no significant difference(P>0.05).The total experimental group after one month of complications was 5.0%,while the control group was 16.7%incidence of postoperative complications in the experimental group was significantly less than in the control group(P<0.05).Postoperative serum IL-6 and IL-10 content of a month are significantly less than the preoperative(P<0.05),while serum IL-6 and IL-10 content after the experimental group were also significantly less than the control group,compared to the differences were statistically significant(P<0.05).Preoperative CD 133 positive expression of the experimental group and the control group were 85.0%and 81.7%respectively,the positive rate of 1 month after surgery was 6.7%and 20.0%,respectively,CD133 expression rate of the experimental group after a month of all significantly lower than the control group(P<0.05).In the 120 cases of patients with colorectal cancer,CD 133 in different Dukes staging,the positive expression rate contrast difference differentiation and lymph node metastasis tissues was statistically significant(P<0.05).Follow-up to date?ConclusionLaparoscopic surgery in the treatment of colorectal cancer with traditional open surgery compared to high security,and has a short recovery time,in patients with bleeding,intestinal peristalsis quick recovery,postoperative hospitalization time is short,the postoperative indwelling catheter is only a few days,postoperative complications and other advantages;at the same time,the cavity mirror group and laparotomy group node in patients with rectal cancer compared,postoperative serum IL-6 and IL-10 significantly reduced;CD 133 positive rate decreased significantly;Laparoscopic surgery for colorectal cancer can promote the rehabilitation of patients,fewer complications,the role of trauma and stress response in patients with less,the mechanism may be able to effectively reduce the expression of CD 133 molecules. |
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