微创腹腔镜与开腹手术联合快速康复技术治疗直肠癌临床研究

Clinical study on laparoscopic and open operation combined with fast-track surgery in treating rectal cancer

目的研究腹腔镜与开腹手术联合快速康复技术(FTS)治疗直肠癌的临床价值。方法将直肠癌患者120例纳入研究对象,随机分为Ⅰ组(传统开腹手术组)、Ⅱ组(传统开腹术+FTS)、Ⅲ(腹腔镜手术组)、Ⅳ组(腹腔镜术+FTS)各30例,比较手术相关指标、应激反应、术后并发症。结果 1手术指标:腹腔镜手术组(Ⅲ组、Ⅳ组)手术时间明显长于开腹手术组(Ⅰ组、Ⅱ组),术中出血量、切口长度明显低于开腹手术组;快速康复技术组(Ⅱ组、Ⅳ组)住院时间明显短于常规围手术期处理组(Ⅰ组、Ⅲ组);Ⅱ组、Ⅲ组、Ⅳ组首次通气时间、下床活动时间明显早于Ⅰ组(P<0.05);2应激指标:腹腔镜手术组(Ⅲ组、Ⅳ组)IL-6、WBC明显低于开腹手术组(Ⅰ组、Ⅱ组);术后7 d CRP、IL-6、WBC均明显低于开腹组(P<0.05);快速康复组(Ⅱ组、Ⅳ组)CRP、IL-6、WBC均低于对应手术的围手术期常规处理组(Ⅰ组、Ⅲ组)(P>0.05);3并发症:Ⅰ、Ⅱ、Ⅲ、Ⅳ组术后并发症发生率分别为16.67%、10%、10%及6.67%,比较差异无显著性(P>0.05)。结论腹腔镜下手术联合快速康复技术有助于促进术后恢复、缓解应激反应,是直肠癌较理想的治疗模式。

【Objective】To study the clinical value of laparoscopic and open operation combined with fast-track surgery in treating rectal cancer. 【Methods】120 cases patients with rectal cancer were divided into groupⅠ（traditional open surgery group）, group Ⅱ（traditional laparotomy surgery ＋FTS）, group Ⅲ（laparoscopic surgery group）,group Ⅳ（laparoscopic ＋FTS）, operation indicators, stress response and postoperative complications between four groups were compared. 【Results】1Operation indicators： laparoscopic surgery group（group Ⅲ, Ⅳ） surgery time were significantly longer than open surgery group（groupⅠ, Ⅱ）, intraoperative blood loss, length of incision were significantly lower than the open surgery group; FTS（groupⅡ, Ⅳ） hospitalization time was significantly shorter than the conventional perioperative treatment group（groupⅠ, Ⅲ）; groupⅡ, groupⅢ, Ⅳ anal exhaust time, getting out of bed time were significantly earlier than groupⅠ（P〈0.05）; 2Stress indicators： laparoscopic surgery group（groupⅢ, Ⅳ） 1day postoperative IL-6, WBC were significantly lower than open surgery group（groupⅠ, Ⅱ）; After 7 d, CRP, IL-6,WBC were significantly lower than open surgery group（P〈0.05）; FTS group（groupⅡ, Ⅳ） CRP, IL-6, WBC were lower than the corresponding perioperative routine treatment group（groupⅠ, Ⅲ）, there were no statistically significantly differences（P〉.05）; 3There was no significant difference of postoperative complications among group Ⅰ,Ⅱ, Ⅲ, Ⅳ（16.67%, 10%, 10%, 10%）（P〉0.05）.【Conclusion】Laparoscopic operation combined with FTS is an ideal treatment mode in rectal cancer for it can alleviate stress response and promote postoperative recovery.