腹腔镜全直肠系膜切除术对低位直肠癌患者术后胃肠功能的影响

Analysis of laparoscopic total mesenteric excision on gastrointestinal function for patients with low rectal cancer after operation

目的分析腹腔镜全直肠系膜切除术对低位直肠癌患者术后胃肠功能的影响。方法选取165例确诊为低位直肠癌的患者作为研究对象,排除脱落对象后分为观察组(81例)与对照组(81例)。观察组接受腹腔镜全直肠系膜切除术,对照组接受传统开腹全直肠系膜切除术。由该院专科医师收集并评定手术时间、切口长度、住院时间、术中出血量、术后开始进食时间、术后肛门排气时间、清除淋巴结数目和疼痛情况。由该院专科医师随访收集并评定两组患者生存、复发以及并发症发生情况。胃泌素(GAS)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8)采用酶联免疫吸附法(ELISA)测定。结果两组患者清除淋巴结数目比较,差异无统计学意义(P>0.05)。两组治疗后的手术时间、切口长度、住院时间、术中出血量、术后开始进食时间、术后肛门排气时间以及视觉模拟评分(VAS)比较,差异均有统计学意义(P <0.05),虽然观察组手术时间长于对照组,但观察组切口长度、住院时间、术中出血量、术后开始进食时间、术后肛门排气时间以及VAS评分均优于对照组。两组患者均未出现局部复发、远处转移及死亡的病例。观察组并发症发生率(13.58%)较对照组并发症发生率(30.86%)低,差异有统计学意义(P <0.05)。两组患者术前GAS、IL-6及IL-8水平比较,差异均无统计学意义(P>0.05);术后即刻、术后1 d和术后3 d两组的GAS、IL-6及IL-8水平比较,差异均有统计学意义(P <0.05),观察组GAS水平均较对照组高,IL-6及IL-8水平均较对照组低。结论腹腔镜全直肠系膜切除术对低位直肠癌患者疗效确切,胃肠功能恢复较快,且相对于传统手术对炎症因子有一定的抑制作用。

Objective To analyze the laparoscopic total mesenteric excision on gastrointestinal function for patients with low rectal cancer after operation. Method 165 cases diagnosed as low rectal cancer, patients lost were excluded from the study, which was divided into observation group(81 cases) and control group(81 cases). The control group were treated by the laparoscopic total mesenteric excision, the observation group were treated by traditional open total mesenteric excision. Operative time, incision lengths, hospital stay, intraoperative blood loss, postoperative fasting time, postoperative exhausting time, the number of eliminating lymph nodes and ache situation were collected and evaluated by specialist in our hospital. The situation of survival, recurrence and complications were followed and collected by specialist in our hospital. The levels of gastrin, IL-6 and IL-8 were measured by ELISA method. Result The difference was not statistically significant(P > 0.05) in the two groups of the number of eliminating lymph nodes, the difference was statistically significant(P < 0.05) in the two groups of operative time, incision lengths, hospital stay, intraoperative blood loss, postoperative fasting time, postoperative exhausting time and VAS scores. Although the operative time of the observation group was longer than that in control group, but operative time, incision lengths, hospital stay, intraoperative blood loss, postoperative fasting time, postoperative exhausting time and VAS scores were better than that in control group. No local recurrence,metastasis and death were observed in both groups. The difference was statistically significant(P < 0.05) in the two groups of complication rate after treatment, the complication rate in the observation group(13.58%) was lower than that in control group(30.86%). The difference was not statistically significant(P > 0.05) in the two groups of the levels of GAS, IL-6 and IL-8 at preoperative, the difference was statistically significant(P < 0.05) in the two groups of the levels of GAS, IL-6 and IL-8 immediately after the procedure, 1 and 3 days after surgery. The levels of GAS in observation was higher than that in controls. The levels of IL-6 and IL-8 in observation was lower than that in controls. Conclusions Laparoscopic total mesenteric excision is effective with low rectal cancer, and can make the gastrointestinal function recover faster than the usual, might play a certain role in suppressing inflammatory factor compared with traditional operation.