腹腔镜和开腹结直肠癌根治术对胃肠功能影响的对比研究

Comparison study on gastrointestinal function recovery after laparoscopy and open radical resection for colorectal cancer

目的 比较腹腔镜和开腹结直肠癌手术对胃肠功能的影响.方法 149例结直肠癌患者,采用腹腔镜根治术73例,开腹手术76例,两组患者术后均未常规放置胃管,利用放射免疫法测定两组患者手术前和手术后24、48及72h血浆胃动素（MTL）水平,并观察术后肠鸣音恢复和首次肛门排气时间.结果 术前两组血浆MTL水平差异无统计学意义（P〉0.05）,腹腔镜手术组术后24、48h血浆MTL水平较术前明显下降（P〈0.001）,术后72h基本恢复正常（P=0.353）;开腹手术组术后24、48及72h血浆MTL水平均较术前明显下降（P〈0.01）;腹腔镜手术组48、72h血浆MTL水平显著高于同时期开腹手术组（P〈0.05）.腹腔镜手术组肠鸣音恢复时间及术后排气时间较开腹手术组明显提前（P〈0.01）.开腹手术组术后需重插胃管的患者明显多于腹腔镜手术组（P＝0.043）.结论 腹腔镜结直肠癌根治术对胃肠功能的影响明显小于开腹结直肠癌根治术.

Objective To examine the gastrointestinal function recovery after laparoscopy and open radical resection for colorectal cancer. Methods A total of 149 patients with colorectal cancer who were admitted to our hospital between May 2007 and June 2010 underwent either laparoscopy（ n = 73 ）or conventional colorectal resection（ n = 76）. The patients in the two groups were removed of nasogastric tube （NGT） after the surgical procedure. The serum levels of motilin（MTL） were measured by radioimmunoassay（RIA）before and 24,48 and 72 h after the operation. The recovery time of the postoperative bowel sound and the anal exhaust was also recorded. Results There was no significant difference in the preoperative level of MTL between the two groups（P 〉 0.05）. The serum MTL levels at 24 b and 48 h in the laparoscopic group and at 24 h,48 h and 72 h in the conventional group were significantly lower than those in preoperative period（ P 〈 0.01 ）. And the serum MTL level in the laparoscopie group resumed preopera- tive level 72 h after operation （ P = 0. 353 ）. At 48 h and 72 h the serum MTL levels in the laparoscopic group were higher than those in the conventional group（P 〈0.05 ）. The recovery of bowel sound and anal exhaust in the laparoscopic group was earlier than that in the conventional group（ P 〈0.01 ）. Reinsertion of the NGT was required in 19.7% of the patients in the conventional group,compared with 8.2% of the patients in the laparoscopic group （ P = 0. 043 ）. Conclusion The laparoscopy is superior to the conventional colorectal resection in the treatment of coloreetal cancer in terms of the recovery of gastrointestinal function.