关键词: 结直肠肿瘤, 腹腔镜检查, 感染

Abstract:

Objective To explore the characteristics of pathogenic bacteria in colorectal tumor patients with infection after laparoscopic surgery and their impact on the expression of T Helper(Th)1/Th2, monocyte chemoattractant protein-1(MCP-1) and soluble Trigge ring receptor expressed on myeloid cell-1(sTREM-1).

Methods A total of 67 colorectal tumor patients with infection after laparoscopic surgery were selected as the infection group, including 23 with mild infection, 27 with moderate infection, and 17 with severe infection. In addition, 67 patients with colorectal tumors without infection during laparoscopic surgery were selected as the non-infection group. The characteristics of pathogenic bacteria in patients colorectal tumors after laparoscopic surgery were statistically analyzed, and the general data and the levels of Th1/Th2, MCP-1 and sTREM-1 after surgery were compared between two groups. The influencing factors of infection after laparoscopic surgery were analyzed, and the value of Th1/Th2, MCP-1 and sTREM-1 levels in the diagnosis of infection after laparoscopic surgery was evaluated. The correlation between the levels of Th1/Th2, MCP-1, sTREM-1 and the degree of infection was analyzed.

Results The pathogenic bacteria culture results of 67 patients in the infection group showed that 138 pathogenic bacteria were cultured, including 67.39% of gram-negative bacteria, 23.91% of gram-positive bacteria, and 8.70% of others. The proportion of patients with body mass index(BMI) ≥ 24, Dukes stages C and D, diabetes, and duration of operation＞2 h in the infection group was higher than that in the non-infection group, with significant difference(P＜0.05). Logistic regression analysis showed that BMI, Dukes stages C and D, diabetes, duration of operation, and Th1/Th2, MCP-1, and sTREM-1 levels at 3 and 7 d after surgery were all influencing factors for infection after laparoscopic surgery in patients with colorectal tumors(P＜0.05). The receiver operating characteristic(ROC) curve was drawn, which showed that the area under the ROC curve(AUC) of Th1/Th2, MCP-1, and sTREM-1 levels at 3 d after laparoscopic surgery in infection diagnosis was larger than that at 7 d after laparoscopic surgery. The AUC of combined diagnosis was the largest at 3 d after operation, which was 0.913, showing good diagnostic efficiency. There was a negative correlation between Th1/Th2 and the degree of infection in patients with infection after laparoscopic surgery for colorectal tumors, and the level of MCP-1 and sTREM-1 was positively correlated with the degree of infection(P＜0.05).

Conclusion The significant decrease of Th1/Th2 and the significant increase of MCP-1 and sTREM-1 levels in patients with infection after laparoscopic surgery for colorectal tumors can be used for diagnosis and evaluation of infection. The pathogenic bacteria are mainly Escherichia coli and Staphylococcus aureus. Therefore, clinical attention and targeted treatment programs are needed in order to improve the clinical efficacy and the prognosis of patients.

Key words: colorectal neoplasms, laparoscopy, infections