腹壁悬吊腹腔镜手术治疗结肠癌的临床观察

Prognosis of colon cancer treated by abdominal suspension laparoscopic surgery

目的观察腹壁悬吊腹腔镜手术治疗结肠癌的疗效。方法纳入2012年7月至2014年9月于本院接受腹腔镜手术的80例结肠癌患者作为研究对象,随机分为腹壁悬吊腹腔镜组(悬吊组)和气腹腹腔镜组(气腹组),每组各40例。比较两组手术时间、术中出血量、肿瘤距切缘距离、肛门排气时间及淋巴结切除数目,术后1 d和术后1周CD3+、CD4+及CD8+水平,随访记录两组并发症发生情况及术后2年局部复发率、远处转移率、腹膜种植转移率及生存率。结果悬吊组术后肛门首次排气时间和术中出血量显著低于气腹组(P<0.05),两组手术时间、淋巴结切除数及肿瘤距切缘距离差异无统计学意义(P>0.05)。悬吊组术后心律失常、电解质紊乱及高碳酸血症发生率比较差异无统计学意义(P>0.05)。气腹组术后1 d和术后1周CD3+、CD4+及CD8+水平均显著低于悬吊组,差异均有统计学意义(P<0.05)。两组术后2年局部复发率、远处转移率、腹膜种植转移率及生存率差异均无统计学意义(P>0.05)。结论腹壁悬吊式腹腔镜用于结肠癌较传统气腹安全性更高,对机体免疫功能影响小,有利于术后患者早期康复,两组术后2年预后基本相当。

Objective To study the prognosis of colon cancer treated by abdominal suspension laparoscopic surgery. Methods 80 cases of colon cancer patients were randomly assigned to abdominal wall lifting laparoscopic group （suspension group）and laparoscopie group （pneumoperitoneum group）, with 40 cases in each group. The operation time,intraoperative blood loss ,the distance between the tumor and the resection margin, anal exhaust time and the number of lymph nodes resected were compared between the two groups. The com- plications, recurrence and 2-year survival rate of the patients in the two groups were also compared. Results The postoperative anal exhaust time,intraoperative bleeding volume was significantly lower in the suspension group than in the pneumoperitoneum group （P 〈 0.05）. The CD3,CD4 and CD8 1 day and 1 week after operation were significantly lower in the pneumoperitoneum group than in the suspension group （P 〈 0.05）. There was no significant difference in operation time,the number of lymph nodes resected,the distance from the tumor to the ineisal margin ,the postoperative recurrence and metastasis, and the 2-year survival rate between the two groups （P 〉 0.05 ）. Conclusion The abdominal wall lifting laparoscopic for colon cancer has better safety than the traditional pneumoperitoneum, and small effect on immune function. It offers advantage for the early rehabilitation of patients after surgery, but has no significant improvement for long-term survival.