手辅助腹腔镜与腹腔镜辅助手术治疗结直肠癌的对比研究

Comparative study of hand-assisted laparoscopy and laparoscopy-assisted radical operation for colorectal cancer

目的比较手辅助腹腔镜与腹腔镜辅助手术在外科治疗结直肠癌中的近期疗效,评估手辅助腹腔镜外科治疗结直肠癌的安全性及对全身应激炎症的影响。方法选取2012年9月-2016年3月收治的100例结直肠癌患者,按照随机数字表法分为腹腔镜辅助治疗组(A组,n=63)与手辅助腹腔镜治疗组(B组,n=37),对比两组手术相关指标、术后并发症及全身应激炎症反应水平。结果 B组在手术时间、手术出血量、引流量均优于A组(P<0.05),排气时间较A组长(P<0.05)。两组术后住院时间及术后并发症发生率的差异无统计学意义(P>0.05)。B组全身应激炎症反应指标中性粒细胞数和C反应蛋白(CRP)与A组差异无统计学意义(P>0.05),而B组血清中炎症因子白细胞介素-6(IL-6)水平高于A组水平,差异有统计学意义(P<0.05)。结论在结直肠癌治疗中,手辅助腹腔镜手术具有手术时间短、术中出血量低等优点,但腹腔镜辅助手术在术后胃肠功能恢复方面更具优势,手辅助腹腔镜手术的全身炎症因子IL-6水平高于腹腔镜组,在临床应用时应依据实际情况合理选取腹腔镜手术术式。

Objective To compare the short-term efficacy of hand-assisted laparoscopic surgery and laparoscopy-assisted radical operation, and evaluate the safety of hand-assisted laparoscopic surgery and its effect on systemic stress inflammation in colorectal cancer. Methods Totally 100 patients who had colorectal cancer and underwent radical operation from September 2012 to March 2016 were selected and divided into hand-assisted laparoscopy group （Group A, n = 63） and laparoscopy-assisted group （Group B, n = 37） according to the random number table. We compared operation index, postoperative complications and systemic inflammatory response levels in the two groups. Results Group B outperformed Group A in operation time, bleeding volume and drainage volume （P〈0.05）, but with longer flatus time after operation than that in Group A （P〈0.05）. There was no significant difference in hospitalization length and the incidence of postoperative complications between the two groups （P 〉 0.05）. Systemic inflammatory reaction index of neutral granulocyte number and C reactive protein （CRP） showed no significant differences between the two groups （P〉0.05）, but inflammatory cytokine IL-6 level in Group B was significantly higher than the that in Group A （P〈0.05）. Conclusion Hand-assisted laparoscopic surgery has shorter operation time, lower bleeding volume than laparoscopy-assisted operation in the treatment of colorectal cancer, but the latter one has more advantages in postoperative gastrointestinal function recovery. The inflammatory cytokine IL-6 level in hand-assisted laparoscopic surgery is higher than that in laparoscopy, suggesting that the choice of operation methods should be based on the actual situation in clinical application.