LAS与HALS对结直肠癌的手术疗效及手术应激创伤反应比较

Comparison of efficacy and post-trauma stress response between LAS and HALS in treatment of colorectal cancer

目的比较分析腹腔镜辅助手术(LAS)与手辅助腹腔镜手术(HALS)治疗结直肠癌的临床疗效及创伤应激反应情况。方法根据不同术式将75例结直肠癌患者分为LAS组与HALS组,比较两组手术疗效相关指标及术后应激因子指标变化。结果与HALS组比较,LAS组术后排气时间显著短,术后疼痛视觉模拟评分(VAS)显著低,而手术时间显著长,术中出血量均显著多(P<0.05);两组术后并发症发生率比较无统计学差异(P>0.05);与术前比较,两组术后24 h外周血白细胞计数(WBC)和血清C反应蛋白(CRP)、皮质醇(P)、白介素-6(IL-6)水平均显著升高(P<0.05),且HALS组IL-6水平显著高于LAS组(P<0.05)。结论相比LAS,HALS治疗具有手术时间短、术中出血量少的优点,而LAS具有术后排气时间短、疼痛轻的优点;LAS和HALS均会导致一定的创伤应激反应,而HALS创伤应激反应相对较大。

Objective To compare and analyze the clinical efficacy and post-trauma stress responses of laparoscopic assisted surgery （LAS） and hand-assisted laparoscopic surgery （HALS） in the treatment of colorectal cancer. Methods A total of 75 patients with colorectal cancer were divided into a LAS group and a HALS group according to the surgery performed on them, and the changes in efficacy related indexes and post-operative stress factors were compared between the two groups. Results The post-operative anus evacuation time was significantly shorter and the visual analogue score （VAS） remarkably lower, while the operative time was much longer and the amount of intra-operative bleeding noticeably higher in the LAS group than those in the HALS group （P 〈 0.05）; the incidence of post-operative comphcations showed no statistical difference between the two groups （P 〉 0.05）; 24 h after the operation, the peripheral blood white blood cell counts （WBC） and the levels of serum C-reactive protein （CRP）, cortisol （P） and interleukin-6 （IL-6） increased markedly （P 〈 0.05） as compared with those before the operation, and the IL-6 level in the HALS group was much higher than that in the LAS group （P 〈 0.05）. Conclusion HALS has the advantages of shorter operative time and less intra-operative bleeding, while LAS has the advantages of shorter anus evacuation time and less pain; both will cause certain post-trauma stress response, but that caused by HALS is more severe.