腹腔镜手术治疗结肠癌合并肠梗阻疗效观察

Curative effect of laparoscopic operation on colon cancer complicated with intestinal obstruction

目的评价腹腔镜手术治疗结肠癌合并肠梗阻患者的临床效果。方法回顾性分析2016年7月至2018年11月于汉滨区第二医院普外科进行手术治疗的112例结肠癌合并肠梗阻患者的临床资料,按手术方法的不同将患者分为对照组和观察组,每组56例,对照组患者采用传统开腹手术,观察组采用腹腔镜手术。比较两组患者的手术相关指标、应激相关指标、炎症指标以及术后并发症等情况。结果观察组患者的手术时间、术中出血量、手术切口长度、肛门排气时间及住院时间明显短于对照组,差异均有统计学意义(P<0.05);术前两组患者的皮质醇、醛固酮以及肾上腺素等应急指标比较差异均无统计学意义(P>0.05);观察组患者术后1 d和术后3 d的皮质醇、醛固酮及肾上腺素明显低于对照组,差异均有统计学意义(P<0.05);术前两组患者的肿瘤坏死因子α(TNF-α)、白细胞介素(IL-6)、C反应蛋白(CRP)等炎症指标比较差异均无统计学意义(P>0.05);观察组患者术后1 d和术后3 d的TNF-α、IL-6及CRP明显低于对照组,差异均有统计学意义(P<0.05);观察组患者术后并发症发生率7.14%,明显低于对照组的21.43%,差异有统计学意义(P<0.05)。结论腹腔镜手术治疗结肠癌合并肠梗阻能有效降低患者的应激反应和炎症指标,减少患者术后并发症,加快患者术后恢复,值得临床推广应用。

Objective To observe the effect of laparoscopic surgery on colon cancer patients with intestinal obstruction. Methods The clinical data of 112 patients with colon cancer and intestinal obstruction who underwent surgery in Department of General Surgery, Hanbin District Second Hospital from July 2016 to November 2018 was retrospectively analyzed. According to the different surgical methods, the patients were divided into the control group and observation group, with 56 cases in each group. The patients in the control group were treated with traditional open surgery,and patients in the observation group were treated with laparoscopic surgery. The operation related indexes, stress related indexes, inflammation indexes, and postoperative complications were compared between the two groups. Results The operation time, intraoperative bleeding volume, incision length, anal exhaust time, and hospitalization time of the patients in the observation group were significantly shorter than those in the control group(all P<0.05);there was no statistically significant difference between the two groups in cortisol, aldosterone, epinephrine and other emergency indicators(all P>0.05);the cortisol, aldosterone and adrenaline in the observation group were significantly lower than those in the control group at 1 d and 3 d after surgery, and the differences was statistically significant(P<0.05);there was no statistically significant difference between the two groups in the inflammatory indicators including tumor necrosis factor α(TNF-α), interleukin(IL-6), C-reactive protein(CRP) before surgery(P>0.05);the TNF-α, IL-6 and CRP in the observation group were significantly lower than those in the control group(all P<0.05);the incidence of postoperative complications in the observation group was 7.14%, which was significantly lower than 21.43% in the control group(P<0.05).Conclusion Laparoscopic surgery can effectively decrease the stress response and inflammatory indicators of colon cancer patients with intestinal obstruction, reduce postoperative complications, and accelerate postoperative recovery,which is worthy of clinical application.