腹腔镜和开腹右半结肠癌手术对患者术后胃肠功能、疼痛及并发症的影响

Effect of laparoscopic and open right hemicolectomy on gastrointestinal function and pain in patients with colorectal cancer

目的观察腹腔镜和传统开腹手术对右半结肠癌患者术后胃肠功能恢复、疼痛及并发症的影响情况。方法选取2011年10月至2016年5月于江苏省江阴市长泾医院、无锡市第四人民医院两院收治的58例右半结肠癌患者,随机分成腹腔镜手术组和开腹手术组(每组各29例),比较两组患者术中情况,手术前后疼痛视觉模拟评分(VAS)以及术后胃肠功能恢复情况,及术后1周内并发症发生率。结果腹腔镜手术组患者术中出血量低于开腹手术组(P<0.05),手术时间、淋巴结清扫数量比较差异无统计学意义(P>0.05)。腹腔镜手术组患者术后肠鸣音恢复时间、首次排气时间、恢复进食时间均显著短于开腹手术组(均P<0.05),术后首次离床活动时间、平均住院时间均显著早于开腹手术组(均P<0.05);两组患者术前VAS评分无明显差异(P>0.05),而术后1 d、7 d腹腔镜手术组VAS评分低于开腹手术组,两组差异有统计学意义(P<0.05);腹腔镜手术组并发症总发生率与开腹手术组相当,差异无统计学意义(P>0.05)。结论腹腔镜右半结肠癌手术较常规开腹手术出血少,术后患者疼痛程度较轻,胃肠道功能恢复快,更有利于患者尽快恢复。

Objective To investigate Effect of laparoscopic and open right hemicolectomy on gastrointestinal function and pain in patients with colorectal cancer. Methods 58 cases of colorectal cancer patients were recruited from Jiangyin Mayor Jingyang Hospital in Jiangsu Province and Wuxi Fourth People＇s Hospital from October 2011 to May 2016. Patients were randomly assigned to laparoscopy group and laparotomy group, with 29 cases in each group. Patients in the laparoscopy group received laparoscopic right hemicolectomy and patients in the laparotomy group received open hemicolectomy. The visual analogue scale（VAS） score and postoperative gastrointestinal function recovery were compared between the two groups before and after surgery, and the incidence of complications was recorded within 1 weeks. Results The total volume of blood loss in the laparoscopy group was lower than that in the laparotomy group.There was no significant difference in the operation time and the number of dissected lymph node（P〉0.05）. Gastrointestinal function recovered faster in the laparoscopy group, including earlier bowel sounds, exhaust and eating time（P〈0.05）. They also experienced earlier off-bed activity and shorter hospital stay than the laparotomy group（P〈0.05）. There was no significant difference between the two groups in preoperative VAS score（P〉0.05）. The score at 1 d and 7 d in the laparoscopy group was significantly lower than those in the laparotomy group（P〈0.05）. The overall complication rate in the laparoscopy group is significantly lower than the laparotomy group（P〉0.05）. Conclusion Compared with conventional open surgery, laparoscopic colorectal cancer surgery results in less bleeding, fewer postoperative pain, faster recovery of gastrointestinal function and less adverse reaction.