左半结肠癌合并急性肠梗阻肠减压后腹腔镜辅助Ⅰ期切除吻合术效果

Clinical study and safety analysis of laparoscopic assisted stage I resection and anastomosis in treatment of left colon cancer complicated with acute ileus after intestinal decompression

目的 探讨左半结肠癌合并急性肠梗阻肠减压后腹腔镜辅助Ⅰ期切除吻合术的临床疗效及安全性。方法 选取2015-06至2021-11解放军总医院第三医学中心收治的左半结肠癌合并急性肠梗阻患者66例,根据治疗方法不同分为两组,对照组(33例)采用Ⅰ期切除吻合术治疗,研究组(33例)采用肠减压后腹腔镜辅助Ⅰ期切除吻合术治疗,分析两组临床疗效,对比手术及术后效果相关指标,检测炎症因子指标,记录并发症发生情况,评估患者生活质量。结果 研究组总有效率(100.00%)高于对照组(84.85%)(P<0.05)。研究组患者的淋巴结清除数量(12.34±1.34)多于对照组(11.21±1.08),胃肠功能恢复时间[(3.40±0.66)d]、下床活动时间[(41.53±4.30)h]及住院时间[(18.31±3.69)d]均短于对照组[(5.49±0.95)d,(46.28±3.53)h,(26.60±3.13)d](P<0.05)。两组血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)较术前均明显降低,且术后1周研究组TNF-α[(19.18±1.90)pg/ml]、CRP[(30.95±4.00)mg/L]明显低于对照组(P<0.05)。研究组并发症总发生率(9.09%)低于对照组(30.30%)(P<0.05)。研究组患者的躯体功能、心理功能、物质生活以及社会功能评分均明显高于对照组(P<0.05)。结论 肠减压后腹腔镜辅助Ⅰ期切除吻合术可有效提高左半结肠癌合并急性肠梗阻患者的临床疗效,并能促进胃肠功能恢复,缩短住院时间,改善生活质量,且安全性较高。

Objective To analyze the clinical efficacy and safety of laparoscopic assisted stage I resection and anastomosis in the treatment of left colon cancer complicated with acute ileus.Methods A total of 66 patients with left colon cancer complicated with acute ileus who were admitted to our hospital from June 2015 to November 2021 were selected as the research objects. The control group(33 cases) were treated with stage I resection and anastomosis, and the research group(33 cases) were treated with stage I laparoscopic-assisted resection and anastomosis after decompression. The clinical efficacy of the two groups was analyzed. The indexes related to operation and postoperative effect of the patients were compared, inflammatory factors indexes of patients were detected, complications of patients were recorded, and the quality of life of patients was evaluated.Results After operation, the total effective rate of the study group(100.00%) was significantly higher than that of the control group(84.85%)(P<0.05). The number of lymph node clearance in the study group(12.34±1.34) was significantly higher than that in the control group(11.21±1.08), and the recovery time of gastrointestinal function[(3.40±0.66)d], ambulation time[(41.53±4.30) h]and hospitalization time[(18.31±3.69) d]were significantly lower than those in the control group(P<0.05). The levels of serum C-reactive protein(CRP)[(30.95±4.00) mg/L]and tumor necrosis factor-α(TNF-α)[(19.18±1.90)pg/ml]in the study group were significantly lower than those in the control group one week after operation(P<0.05). The total incidence of complications in the study group(9.09%) was significantly lower than that in the control group(30.30%)(P<0.05). The scores of physical function, psychological function, material life and social function in the study group were significantly higher than those in the control group(P< 0.05).Conclusions Laparoscopic stage I resection and anastomosis after intestinal decompression can effectively improve the clinical efficacy of patients with left colon cancer complicated with acute ileus, and can promote gastrointestinal function recovery, shorten the length of hospital stay, and improve the quality of life, with high safety, which is worthy of clinical application.