腹腔镜和开腹肝切除治疗结直肠癌肝转移的临床探讨

Clinical Investigation of Laparoscopic and Open Hepatectomy for Liver Metastases from Colorectal Cancer

目的探讨腹腔镜和开腹肝切除治疗结直肠癌肝转移中的临床效果。方法方便该院2016年1月-2018年12月接诊的CRLM患者52例按照患者手术方式的差异分为观察组与对照组两组,每组26例,观察组实施腹腔镜手术治疗,对照组为开腹式手术法,观察两组的手术时间、出血量、住院时间、手术并发症、肝功能指标等。结果两组患者的一般手术指标比较,观察组的手术时间(179.93±22.36)min明显短于对照组(193.64±16.48)min,差异有统计学意义(t=5.701,P=0.023<0.05);观察组的术中出血量(81.06±18.74)mL明显少于对照组(153.17±28.63)mL,差异有统计学意义(t=8.497,P=0.014<0.05);观察组的住院时间(11.03±2.64)d明显短于对照组(16.03±3.25)d,差异有统计学意义(t=6.602,P=0.020<0.05),观察组与对照组的手术时间、术中出血量、住院时间3个指标差异有统计学意义(P<0.05)。观察组出现胸腔感染、肠梗阻、胸腔积液、房颤、切口感染等总发生率7.69%明显低于对照组19.23%,差异有统计学意义(χ^2=16.942,P=0.001<0.05)。结论相对来说,腹腔镜对结直肠癌肝转移症的治疗对开腹肝切除治疗价值更高,更值得临床实践和推广。

Objective To discuss the clinical effect of laparoscopic and open hepatectomy in the treatment of liver metastases from colorectal cancer.Methods Convenient selection of 52 patients with CRLM who were admitted to the hospital from January 2016 to December 2018 were divided into observation group and control group according to the difference of surgical methods.Each group had 26 cases.The observation group was treated with laparoscopic surgery.The control group underwent open surgery,and the operation time,blood loss,hospital stay,surgical complications,and liver function indexes were observed.Results Compared with the control group,the operation time(179.93±22.36)min in the observation group was significantly shorter than that in the control group(193.64±16.48)min(t=5.701,P=0.023<0.05).The intraoperative blood loss(81.06±18.74)mL in the observation group was significantly lower than that in the control group(153.17±28.63)mL,with statistically significant difference(t=8.497,P=0.014<0.05).The length of hospital stay(11.03±2.64)d in the observation group was significantly shorter than that in the control group(16.03±3.25)d,with a statistically significant difference(t=6.602,P=0.020<0.05).There were statistically significant differences in the operation time,intraoperative blood loss and hospital stay between the observation group and the control group(P<0.05).The overall incidence of thoracic infection,intestinal obstruction,pleural effusion,atrial fibrillation and incision infection in the observation group was 7.69%significantly lower than that in the control group(19.23%),with statistically significant differences(χ^2=16.942,P=0.001<0.05).Conclusion Relatively speaking,laparoscopic treatment of colorectal cancer with liver metastases is more valuable for open abdominal resection,and it is worthy of clinical practice and promotion.