两种术式治疗结肠癌患者的临床疗效及血清胃泌素、肝细胞生长因子变化水平比较

Comparison of the Clinical Effect and Serum Gastrin and Hepatocyte Growth Factor Level Changes of Two Kinds of Operation Treating Colon Cancer

目的比较两种术式治疗结肠癌患者的临床疗效及血清胃泌素、肝细胞生长因子变化水平。方法选择2012年5月至2015年5月大连大学附属新华医院肛肠科收治的80例结肠癌患者作为研究对象,按照随机数字表法分为治疗1组(40例)和治疗2组(40例),两组患者均行分期手术,治疗1组Ⅰ期行回肠袢式造口术,治疗2组Ⅰ期行结肠造口术,术后3个月两组均再行Ⅱ期造口闭合术。比较两组患者Ⅰ期、Ⅱ期的手术时间、首次排气时间、住院时间及并发症发生率;分别于Ⅰ期和Ⅱ期术前、术后1d、术后3d、术后7 d检测两组患者血清胃泌素、肝细胞生长因子水平。结果治疗1组Ⅰ期手术首次排气时间[(2.5±0.6)d]显著短于治疗2组[(4.5±0.8)d],差异有统计学意义(P<0.05);治疗1组Ⅱ期手术时间[(1.3±0.4)min]、首次排气时间[(3.1±0.6)d]、住院时间[(6.2±1.3)d]均显著短于治疗2组[(2.4±0.3)min、(4.9±0.9)d、(8.8±1.9)d],差异有统计学意义(P<0.05)。两组患者Ⅰ期、Ⅱ期术后血清胃泌素、肝细胞生长因子均显著降低,与术前比较差异有统计学意义(P<0.05);两组间手术前后各时段胃泌素、肝细胞生长因子比较差异无统计学意义(P>0.05)。两组患者Ⅰ期并发症发生率比较差异无统计学意义(P>0.05),Ⅱ期手术治疗1组低钾血症发生率(5.0%)显著低于治疗2组(20.0%)(P<0.05)。结论回肠袢式造口术和结肠造口术治疗结肠癌疗效相当,但回肠袢式造口术创伤小、患者胃肠功能恢复快,且并发症发生率低,临床优势更明显。

Objective To compare the clinical effect and serum gastrin and hepatooyte growth factor level changes of two kinds of operation for colon cancer. Methods A total of 80 cases of colon cancer treated in Xinhua Hospital Affiliated to Dalian University from May 2012 to May 2015 were divided into treatment 1 group of 40 cases and treatment 2 group of 40 cases according to random number table method, both groups underwent staged operation：treatment 1 group received loop ileostomy in phase I , treatment 2 group underwent Hartmann operation in phase I, 3 months lator, both groups received stoma closure in phase Ⅱ. The phase Ⅰ, phase Ⅱ operation time, first exhaust time, hospitalization time and complication rate of the two groups were compared;serum gastrin and hepatocyte growth factor levels before and 3 d,5 d ,7 d after operation in phase Ⅰ, Ⅱ were detected respectively. Results Treatment 1 groupphase I first exhaust time（2.5±0. 6 ） d was significantly shorter than that in the treatment 2 group （4.5±0. 8 ） d （ P 〈 0.05 ） ; treatment 1 group phase Ⅱ operation time （ 1.3±0.4） rain, first time exhaust time （ 3.1±0.6） d, hospitalization time （6. 2 ±1.3 ） d were significantly shorter than that in the treatment 2 group [ （ 2. 4±0. 3 ） rain, （ 4. 9±0. 9 ） d, （ 8.8±1.9） d ] （ P 〈 0. 05 ）. Serum gastrin and hepatocyte growth factor in both group were significantly lower after operation （P 〈 0.05 ）, there was no significant difference in gastrin and hepatocyte growth factor between the two groups before and after operation （ P 〉 0.05 ）. There was no significant difference in the incidence of complications between the two groups during phase I （ P 〉 0.05 ）, and kaliopenia rate dur- ing phase Ⅱ in treatment 1 group （5.0%） was significantly lower than that in the treatment 2 group （20. 0% ） （P 〈 0. 05 ）. Conclusion The clinical effect of loop ileostomy and Hartmann operation in treatment with colon cancer is similar, and loop ileostomy is featured with small trauma, rapid gastrointestinal function recovery ,low incidence of complications, therefore is more advantageous in clinical.