腹腔镜与开腹直肠低位双吻合术治疗直肠癌的临床疗效对比

Comparison of clinical efficacy of laparoscopic and low rectal open double anastomosis in the treatment of rectal cancer

目的比较腹腔镜与开腹直肠低位双吻合术治疗直肠癌的临床疗效。方法选择2014年4月至2017年4月本院肛肠科收治且需行直肠低位双吻合术的86例患者作为研究对象,随机分为常规组(n=43,行开腹手术)及研究组(n=43,行腹腔镜手术),对比两组术中及术后情况,手术前后CRP、IL-6、TNF-α水平及并发症发生情况。结果研究组患者手术时间、术中出血量显著少于常规组,差异均有统计学意义(均P<0.05);研究组术后引流量、术后引流时间、早期活动时间、肠胃功能恢复时间及住院时间均显著少于常规组,差异均有统计学意义(均P<0.05)。术前,两组IL-6、CRP及TNF-α水平差异均无统计学意义(均P>0.05);术后,研究组各指标水平均显著低于常规组,差异均有统计学意义(均P<0.05)。研究组并发症总发生率为6.98%,常规组并发症总发生率37.21%,差异有统计学意义(P<0.05)。结论与开腹低位双吻合术相比,腹腔镜低位双吻合术治疗直肠癌的手术相关指标更优,机体应激反应较轻且术后并发症发生率更低。

Objective To compare the clinical efficacy of laparoscopic and rectal low open double anastomosis for rectal cancer.Methods 86 patients with rectal cancer who received low level double anastomosis were recruited. They were randomly assigned to control group（n = 43） with open laparotomy and treatment group（n = 43） with laparoscopic surgery. We compared intraoperative and postoperative situation, the levels of CRP, IL-6 and TNF-α and risk of complications between the two groups. Results Duration of operation and the amount of intraoperative blood loss was significantly less in the treatment group than in the control group, with statistically significant difference（P 〈0.05）. The treatment group also had lower flow rate and shorter postoperative drainage time,shorter time to off-bed activity, shorter time gastrointestinal function recovery and shorter hospital stay than the control group, with statistically significant differences（all P 〈0.05）. There was no statistically significant difference between the two groups in IL-6, CRP and TNF-α levels before surgery（all P 〈0.05）. After surgery, these level were significantly lower in the treatment group than in the control group, with statistically significant differences（all P〈 0.05）. The total complication rate of the treatment group was 6.98%,which was significantly lower than that in the control group（37.21%, P 〈0.05）. Conclusion Compared with the open laparotomy,laparoscopic low-level double anastomosis is better for the treatment of rectal cancer, with less body stress response and lower incidence of postoperative complications.