腹腔镜下腹会阴联合手术治疗低位直肠癌的效果及对患者炎性因子和肛肠功能的影响

Laparoscopic abdominal-perineal surgery in the treatment of low rectal cancer and its influence on inflammatory factors and anorectal function

目的探讨腹腔镜下腹会阴联合手术治疗低位直肠癌的效果及对患者炎性因子和肛肠功能的影响。方法依据手术方式将114例直肠癌患者分为开腹组和腹腔镜组,每组57例,开腹组患者接受开腹会阴联合手术治疗,腹腔镜组患者接受腹腔镜下腹会阴联合手术治疗。比较两组患者围手术期指标、血清炎性因子[白细胞介素(IL)-6、IL-8、血清淀粉样蛋白A(SAA)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]、肛肠动力学指标[肛管最大收缩压(MSP)、直肠肛管抑制反射阈值(AIRT)、高压区长度(HPZ)、直肠静息压(RRP)、肛管静息压(ARP)、直肠最大耐受容量(MTV)]和并发症发生情况。结果腹腔镜组患者手术时间长于开腹组,术中出血量低于开腹组,切口长度、排气恢复时间、自主排尿时间、下床活动时间、拔除引流管时间和住院时间均短于开腹组,差异均有统计学意义(P﹤0.05)。术后1天,腹腔镜组患者IL-6、IL-8、SAA、TNF-α、CRP水平均低于开腹组,SAA/CRP高于开腹组,差异均有统计学意义(P﹤0.05);术后7天,腹腔镜组患者SAA/CRP高于开腹组,差异有统计学意义(P﹤0.05)。术后15天,腹腔镜组患者ARP、MSP、MTV、HPZ水平均高于开腹组,RRP、AIRT水平均低于开腹组,差异均有统计学意义(P﹤0.05)。腹腔镜组患者的术后并发症总发生率为7.02%,低于开腹组患者的22.81%,差异有统计学意义(P﹤0.05)。结论腹腔镜下腹会阴联合手术能够达到开腹手术切除与淋巴清扫效果,能够减轻患者术后炎性反应程度,降低手术操作对肛肠动力学的不良影响,术后并发症风险更小,手术安全性更高。

Objective To explore the effect of laparoscopic abdominal-perineal surger in the treatment of low rectal cancer and its influence on patients’inflammatory factors and anorectal function.Method According to the surgical method,114 patients with rectal cancer were divided into laparotomy group and laparoscopic group,with 57 cases in each group.Patients in the laparotomy group received combined open-peritoneal surgery,and patients in the laparoscopic group received laparoscopic abdominal-perineal surgery.The perioperative indexes,serum inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),serum amyloid A(SAA),tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)],anorectal dynamics indexes[maximum squeeze pressure(MSP),anorectal inhibitory reflex threshold(AIRT),high-pressure zone length(HPZ),rectal resting pressure(RRP),anal resting pressure(ARP),and maximal tolerable rectal volume(MTV)]and the occurrence of complications were compared between the two groups of patients.Result The operation time of the laparoscopic group was longer than that of the laparotomy group,and the amount of intraoperative blood loss was lower than that of the laparotomy group,the incision length,exhaust recovery time,autonomous urination time,ambulation time,drainage tube removal time,and hospitalization were shorter than those of the laparotomy group,and the differences were statistically significant(P<0.05).One day after surgery,the levels of IL-6,IL-8,SAA,TNF-α,and CRP in the laparoscopic group were lower than those in the open group,and SAA/CRP was significantly higher than that in the laparotomy group,and the differences were statistically significant(P<0.05);At 7 days after surgery,the SAA/CRP in the laparoscopic group was higher than that in the laparotomy group,and the difference was statistically significant(P<0.05).15 days after surgery,the levels of ARP,MSP,MTV,and HPZ in the laparoscopic group were higher than those in the laparotomy group,and the levels of RRP and AIRT were lower than those in the laparotomy group,and the differences were statistically significant(P<0.05).The total incidence of postoperative complications in the laparoscopic group was 7.02%,which was lower than the 22.81%in the laparotomy group,and the difference was statistically significant(P<0.05).Conclusion Laparoscopic abdominal-perineal surgery can achieve the effects of open surgical resection and lymphatic dissection,reduce the degree of postoperative inflammatory reactions in patients,and reduce the adverse effects of surgical operations on anorectal dynamics,the risk of postoperative complications is smaller and the operation safety is higher.