粘连松解术结合D3根治术用于老年结肠癌合并粘连性肠梗阻的临床治疗

Clinical application of adhesion release combined with D3 radical resection for elderly patients with colon cancer complicated with intestinal obstruction

目的研究粘连松解术结合D3根治术用于老年结肠癌合并粘连性肠梗阻的临床治疗。方法选取顺义区医院于2013年11月-2018年5月诊断的120例结肠癌患者作为研究对象。根据手术方式的不同分为观察组(72例)和对照组(48例)。观察组行腹腔镜下粘连松解术结合右半结肠癌D3根治术,对照组行开腹粘连松解术结合右半结肠癌D3根治术。观察2组手术各项指标、淋巴清扫情况、术后生活质量以及手术并发症之间的差异。结果经过治疗,观察组术中出血量、肠鸣音恢复时间、排气时间、开始进食时间以及术后住院时间明显低于对照组(P<0.05);观察组和对照组淋巴结清扫数量差异无统计学意义(P>0.05)。按肿瘤浸润深度进行分层分析,结果显示,观察组中T2期患者淋巴结清扫数量较对照组高(P<0.05),其余差异均无统计学意义(P>0.05)。2组患者术后并发症发生率差异无统计学意义。术后3个月,观察组Barthel指数及生活质量综合评定问卷(GQOL-74)评分明显高于对照组,差异具有统计学意义(P<0.05)。结论在遵循肿瘤外科切除原则和严格掌握手术适应证的前提下,腹腔镜下粘连松解术联合D3根治术在老年结肠癌合并粘连性肠梗阻的治疗上是安全可行的,具有创伤小、术后康复快等优点,可作为一种新的治疗途径应用于临床。

Objective To study the clinical applicability of lysis of adhesions combined with D3 radical resection for elderly patients with colon cancer complicated with intestinal obstruction. Methods One hundred and twenty cases of colon cancer diagnosed in our hospital between November 2015 and November 2017 were selected as the subjects for retrospective analysis in order to observe the various surgical indexes, lymph node dissection, postoperative quality of life and the difference in postoperative complications of patients with D3 radical resection combined with D3 radical resection. Results After treatment, there was no statistically significant difference(P<0.05)between the two groups in the amount of intraoperative bleeding, the recovery time of bowel sound, the time of exhaust, the time eating was resumed or the length of hospital stay. The number of lymph nodes dissected was respectively in the observation group and the control group. There was no significant difference between the two groups(P>0.05). The results showed that the number of lymph nodes dissected among T2 patients in the observation group was larger than that of the control group(P<0.05), and the difference was not statistically signif icant in other aspects(P>0.05). There was no signif icant difference in postoperative complications between the two groups. Three months after operation, the Barthel index and GQOL-74 score of the observation group were significantly higher than those of the control group(P<0.05). Conclusion As long as the principles of surgical resection are followed and the indications of operation are ascertained, laparoscopic adhesion release combined with D3 radical operation is safe and feasible for senile colon cancer with sticky intestinal obst r uct ion. It has the advant ages of small t rau ma and quick recover y af ter operat ion. It can be used as a new therapeutic approach in clinical practice.