腹腔镜下结直肠癌切除联合肝转移瘤射频消融术治疗结直肠癌的临床效果

Clinical effect of laparoscopic colorectal cancer resection combined with liver metastases radiofrequency ablation for colorectal cancer

目的探讨腹腔镜下结直肠癌切除联合肝转移瘤射频消融术治疗结直肠癌的临床效果.方法收集运城市中心医院2015年12月至2017年12月收治的结直肠癌肝转移患者60例,回顾性分析其临床资料.依据手术方案将其分为两组,每组30例.开腹组行开腹手术,腹腔镜组则予以腹腔镜下结直肠癌切除联合肝转移瘤射频消融术.记录并比较两组患者围术期相关指标、肿瘤标志物、应激指标、并发症与生存曲线.结果腹腔镜组患者术中失血量、发热时间、术后最高腋温、肠蠕动恢复时间低于开腹组(t=12.513、9.167、5.293、6.234,P<0.05);术后1、3、7d,腹腔镜组胃动素水平高于开腹组(P<0.05),白细胞介素-6水平低于开腹组(P<0.05);术后7d,腹腔镜组CD8+水平高于开腹组(P<0.05);术后3d,腹腔镜组皮质醇水平低于开腹组(P<0.05);术后1d,腹腔镜组血糖水平低于开腹组(P<0.05).术后并发症腹腔镜组切口感染、粘连性肠梗阻所占比例均为3.33%(1/30),低于开腹组的23.33%(7/30)、26.67%(8/30).腹腔镜组1年生存率为86.67%(26/30),开腹组为80.00%(24/30),经Log-rank比较,χ^2=0.473,P=0.492.结论腹腔镜手术联合肝转移瘤射频消融术治疗结直肠癌肝转移,可减少手术损伤,应激反应小,术后恢复快,并发症少,患者生理功能较稳定,但1年生存率未见明显改善.

Objective To investigate the clinical effect of laparoscopic resection of colorectal cancer combined with radiofrequency ablation of liver metastases for colorectal cancer.Methods Sixty patients with colorectal cancer liver metastases from Yuncheng Central Hospital from December 2015 to December 2017 were enrolled.The clinical data were retrospectively analyzed.According to the surgical plan,they were divided into two groups,with 30 cases in each group.The open group underwent open surgery,and the laparoscopic group underwent laparoscopic colorectal cancer resection combined with radiofrequency ablation of liver metastases.Perioperative related indicators,tumor markers,stress indicators,complications and survival curves were recorded and compared between the two groups.Results In the laparoscopic group,intraoperative blood loss,fever time,postoperative maximum temperature,and intestinal peristalsis recovery time were lower than those in the open group(t=12.513,9.167,5.293,6.234,P<0.05).On 1,3,and 7 days after operation,the level of motilin in the laparoscopic group was higher than that in the open group(P<0.05),and the level of interleukin-6(IL-6)was lower than that in the open group(P<0.05).On 7 days after operation,the CD8+level in the laparoscopic group was higher than that in the open group(P<0.05).On 3 days after operation,the cortisol level in the laparoscopic group was lower than that in the open group(P<0.05).On 1 day after operation,the blood glucose level in the laparoscopic group was lower than that in the open group(P<0.05).The proportion of laparoscopic incision infection was same to the adhesive intestinal obstruction in the laparoscopic group,both were 3.33%(1/30),lower than 23.33%(7/30)and 26.67%(8/30)in the open group.The 1-year survival rate of the laparoscopic group was 86.67%(26/30),and that of the open group was 80.00%(24/30).Log-rank analysis showed thatχ^2=0.473,P=0.492.Conclusion Laparoscopic surgery combined with liver metastases radiofrequency ablation for liver metastases from colorectal cancer can reduce surgical injury,with less stress response,faster postoperative recovery,fewer complications,and stable physiological function,but the 1-year survival rate of it is not obviously improved.