结直肠癌患者行腹腔镜根治术效果观察及对炎性反应和应激反应的影响

Effect of laparoscopic radical operation on colorectal cancer patients and its impact on inflammatory response and stress response

目的探讨结直肠癌患者行腹腔镜根治术的效果及对炎性因子和应激反应的影响。方法选择浙江省建德市第一人民医院2018年3月至2020年3月诊治的结直肠癌患者72例,依据不同手术方法分为观察组36例与对照组36例。观察组行腹腔镜结直肠癌根治术,对照组行开腹结直肠癌根治术。比较两组术后并发症和胃肠功能恢复情况及围手术期指标的变化,比较两组术前、术后第3天炎性反应指标C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)和应激反应指标去甲肾上腺素(NE)、皮质醇(Cor)的变化。结果观察组术后并发症发生率低于对照组[11.11%(4/36)比33.33%(12/36)],差异有统计学意义(χ2=5.143,P<0.05)。观察组术后开始进食时间、排气时间和肠鸣音恢复时间短于对照组[(2.15±0.38)d比(3.89±0.56)d、(2.39±0.34)d比(3.58±0.62)d、(2.56±0.43)d比(3.81±0.57)d],差异有统计学意义(t=15.427、10.098、10.504,P<0.05)。观察组住院时间短于对照组[(12.38±3.29)d比(18.74±4.15)d],术中失血量少于对照组[(93.17±16.52)ml比(158.93±21.09)ml],而手术时间长于对照组[(185.63±23.14)min比(129.90±18.76)min],差异均有统计学意义(t=7.206、14.728、11.225,P<0.05)。观察组术后第3天血清CRP、TNF-α和IL-6水平低于对照组[(17.84±3.87)mg/L比(32.16±5.64)mg/L、(307.12±15.64)ng/L比(369.84±21.25)ng/L、(84.62±5.89)ng/L比(98.93±7.74)],差异有统计学意义(t=12.561、14.263、8.828,P<0.05)。观察组术后第3天血清NE和Cor水平低于对照组[(187.34±14.62)ng/L比(235.27±19.83)ng/L、(103.24±12.09)μg/L比(147.86±20.12)μg/L],差异有统计学意义(t=11.673、11.405,P<0.05)。结论结直肠癌患者采用腹腔镜根治术较传统开腹手术胃肠功能恢复快,术后并发症少,且对炎性反应和应激反应影响小。

Objective To investigate the effect of laparoscopic radical operation on patients with colorectal cancer and its impact on inflammatory factors and stress response.Methods The clinical data of 72 patients with colorectal cancer treated in Jiande First People′s Hospital from March 2018 to March 2020 were analyzed.The patients were divided into the observation group(36 cases)and the control group(36 cases)according to different surgical methods.The observation group received laparoscopic radical operation,while the control group underwent open radical operation.The postoperative complications,gastrointestinal function recovery,and perioperative indexes and the changes of inflammatory reaction indexes C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6),and stress response indexes noradrenaline(NE),cortisol(Cor)before operation and 3 d after operation were compared between the two groups.Results The postoperative complications rate in the observation group was lower than that in the control group:11.11%(4/36)vs.33.33%(12/36),and the difference was statistically significant(χ2=5.143,P<0.05).The time to start eating,exhaust time and recovery time of bowel sounds in the observation group were shorter than those in the control group:(2.15±0.38)d vs.(3.89±0.56)d,(2.39±0.34)d vs.(3.58±0.62)d,(2.56±0.43)d vs.(3.81±0.57)d,and the differences were statistically significant(t=15.427,10.098,10.504,P<0.05).The hospitalization time in the observation group was shorter than that in the control group[(12.38±3.29)d vs.(18.74±4.15)d],the intraoperative blood loss was less than that in the control group[(93.17±16.52)ml vs.(158.93±21.09)ml],the operation time was longer than that in the control group[(185.63±23.14)min vs.(129.90±18.76)min],and the differences were statistically significant(t=7.206,14.728,11.225,P<0.05).Three days after operation,the levels of CRP,TNF-αand IL-6 in the observation group were lower than those in the control group:(17.84±3.87)mg/L vs.(32.16±5.64)mg/L,(307.12±15.64)ng/L vs.(369.84±21.25)ng/L,84.62±5.89)ng/L vs.(98.93±7.74)ng/L,and the differences were statistically significant(t=12.561,14.263,8.828,P<0.05).Three days after operation,the levels of NE and Cor in the observation group were lower than those in the control group:(187.34±14.62)ng/L vs.(235.27±19.83)ng/L,(103.24±12.09)μg/L vs.(147.86±20.12)μg/L,and the differences were statistically significant(t=11.673,11.405,P<0.05).Conclusions Laparoscopic radical operation has obvious effect on patients with colorectal cancer.It can shorter the recovery time of bowel function,and has less postoperative complications,little influence on inflammatory reaction and stress response.