平行重叠吻合法结合完整结肠系膜切除术在腹腔镜结肠癌治疗中的应用及对序贯器官衰竭评分的影响

Parallel overlapping anastomosis combined with complete mesocolic excision in the treatment of laparoscopic surgery for colon cancer and the effects on SOFA

目的探讨平行重叠吻合法结合完整结肠系膜切除术(CME)在腹腔镜结肠癌治疗中的应用及对序贯器官衰竭评分(SOFA)评分的影响。方法选取2016年11月至2017年11月间上海市浦东新区公利医院收治行结肠癌切除术的90例患者进行回顾性分析。将采用腹腔镜下常规结肠癌根治术基础上联合CME理念治疗的45例患者纳入观察组,采用腹腔镜下行常规结肠癌根治术治疗的45例患者纳入对照组。比较两组患者的术中指标、术后临床疗效、术后指标、SOFA评分、不良反应发生情况以及6个月复发率。结果观察组的治疗有效率显著高于对照组,差异有统计学意义(P<0.05)。观察组的手术时间和术中出血量显著低于对照组,淋巴结清除数目显著高于对照组,差异均有统计学意义(均P<0.05)。观察组的肛门排气时间和住院时间显著低于对照组,差异均有统计学意义(均P<0.05)。术后1d两组SOFA评分比较,差异无统计学意义(P>0.05),术后3d观察组的SOFA评分显著低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05),观察组的6个月复发率显著低于对照组,差异无统计学意义(P<0.05)。结论平行重叠吻合法联合CME理念可更好的清除结肠癌患者淋巴结,降低复发率,减少对患者的损伤,促进术后恢复,也可以降低SOFA评分,改善预后。

Objective To explore parallel overlapping anastomosis combined with complete meso- colic excision （CME） in the treatment of laparoscopic colon cancer and the effects on sepsis-related organ failure assessment （ SOFA ）. Methods A total of 90 patients undergoing resection for colon cancer at Shanghai Pudong New Area Gongli Hospital between November 2016 and November 2017 were enrolled and retrospectively analyzed. They were divided into an observation group and a control group with 45 patients in each group. The observation group was treated with radical resection for colon on the basis of CME and the control group only underwent traditional laparoscopie surgery for colon cancer. , The intraoperative parame- ters, postoperative clinical efficacy, postoperative parameters, SOFA score, adverse reactions, and 6-month recurrence rate were compared between the two groups. Results The efficacy rate of treatment was signifi- cantly higher in the observation group than in the control group （ P 〈 0. 05 ）. The operation time and intraop-erative blood loss were significantly lower in the observation group than in the control group, and the number of lymph node removed was significantly higher in the observation group than in the control group （ all P 〈 O. 05 ）. The anus exhaust time and length of hospital stay were significantly lower in the observation group than in the control group （ all P 〈 0. 05 ）. There was no significant difference in SOFA scores between the two groups at 1 d after the surgery （P 〉 0. 05）, and SOFA scores were significantly lower in the observation group than in the control group at 3 d after the surgery （ P 〈 0. 05 ）. There was no significant difference in the incidence of adverse reactions between the two groups （ P 〉 O. 05 ）. The 6-month recurrence rate was significantly lower in the observation group than in the control group （ P 〈 0. 05 ）. Conclusion Parallel o- verlapping anastomosis combined with CME can better remove the lymph nodes, reduce the recurrence rate, reduce the damage and promote postoperative recovery in patients with colon cancer. At the same time, it also reduces SOFA score and imoroves oromaosis.