手辅助腹腔镜在肥胖结直肠癌患者中的应用价值及疗效分析

Analysis of the value and curative effect of hand assisted laparoscopy in patients with obesity and colorectal cancer

目的分析手辅助腹腔镜(HALS)在肥胖结直肠癌病人中的应用价值及疗效。方法肥胖结直肠癌病人90例,根据随机数字法分为观察组和对照组,每组45例。观察组采取HALS手术,对照组采取开腹手术。比较两组病人手术情况、术后情况、机体应激反应。结果两组手术时间、淋巴结清扫数量比较无显著差异(P> 0. 05),观察组的麻醉时间、术中出血量、刀口长度显著小于对照组(P <0. 05)。观察组术后体温恢复时间、肛门排气时间、下床活动时间、进食时间、住院时间显著短于对照组(P <0. 05)。术前,两组病人白介素(IL)-6、C-反应蛋白(CRP)、皮质醇、促肾上腺皮质激素(ACTH)水平比较,差异无统计学意义(P> 0. 05),术后2天,两组病人IL-6、CRP、皮质醇、ACTH、IL-6、C-反应蛋白(CRP)、皮质醇、促肾上腺皮质激素(ACTH)水平较术前显著上升(P <0. 05),观察组低于对照组(P <0. 05)。两组病人术后镇痛率比较,差异无统计学意义(P>0. 05),观察组的并发症发生率低于对照组(P <0. 05)。结论肥胖结直肠癌病人经HALS术治疗,能减少术中出血量,降低受创程度,有利于病人术后尽快恢复,减少并发症发生率。

Objective To analyzethe value and curative effect of hand assisted laparoscopy in patients with obesity and colorectal cancer. Methods 90 patients with obesity and colorectal cancer admitted in our hospital,they were divided into observation group and control group according to random number method and 45 patients in each group. The observation group were taken HALS surgery,the control group were taken open surgery. The operation conditions,postoperative condition and stress response of the two groups were compared. Results There was no significant difference in operation time,number of lymph node dissection between the two groups（ P〉0. 05）. The anesthesia time,blood loss and incision length in the observation group were significantly less than those in the control group（ P〈0. 05）. Postoperative body temperature recovery time,anal exhaust time,ambulation time,eating time,hospitalization time in the observation group was significantly shorter than the control group（ P〈0. 05）. Before operation,there was no significant difference between the two groups in the levels of interleukin-6（ IL-6）,CRP,cortisol and adrenocorticotropic hormone（ ACTH）（ P〉0. 05）,after two days of operation,the levels of IL-6,CRP,cortisol,interleukin-6,C-reactive protein,cortisol and adrenocorticotrophic hormone in patients with ACTH were significantly higher than those before operation（ P〈0. 5）. The level of observation group was significantly lower than that of control group（ P〈0. 05）. There was no significant difference in postoperative analgesia between the two groups（ P〉0. 05）. The complication rate in the observation group was significantly lower than that in the control group（ P〈0. 05）. Conclusion HALS surgery in patients with obesity and colorectal cancer can reduce the amount of intraoperative bleeding and reduce the degree of involvement,is conducive to the recovery of patients as soon as possible,and reduce the incidence of complications.