腹腔镜下结肠全系膜切除术对结肠癌患者肝肠循环的近期影响

Short term effect of laparoscopic complete mesocolic excision on hepatoenteral circulation in patients with colon cancer

目的探讨腹腔镜下结肠全系膜切除术(CME)对结肠癌(CC)患者肝肠循环的近期影响。方法选取2019年7月至2020年7月江西省赣州市人民医院收治的CC患者60例作为研究对象进行前瞻性随机试验,采用交替分组法分为对照组(30例)与观察组(30例)。对照组采用传统开腹手术治疗,观察组采用腹腔镜下结肠全系膜切除术治疗。比较两组患者的手术疗效,对比两组手术前及术后1 d的血清25-羟维生素D_(3)[25(OH)D_(3)]及血清胆红素(TBil)水平,统计两组术后并发症发生情况。结果观察组的治疗总有效率高于对照组,并发症总发生率低于对照组,差异有统计学意义(P<0.05);两组术后的血清25(OH)D_(3)及TBil水平低于术前,观察组术后的血清25(OH)D_(3)水平高于对照组,而TBil水平低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜下CME应用于CC患者的治疗中的效果较佳,能够有效改善肝肠循环,且术后并发症发生率较低,可为术后近期营养和免疫疗法提供药物选择的依据。

Objective To investigate the short-term effect of laparoscopic complete mesocolic excision(CME)on hepatoenteral circulation in patients with colon cancer(CC).Methods A total of 60 patients with CC admitted to People′s Hospital of Ganzhou City,Jiangxi Province from July 2019 to July 2020 were selected as the research subjects for a prospective randomized trial.They were divided into a control group(30 cases)and an observation group(30 cases)according to the alternating grouping method.The control group was treated with traditional laparotomy,and the observation group was treated with laparoscopic complete mesocolic excision.The curative effect compared between the two groups,and the levels of serum 25 dihydroxyvitamin D_(3)(25[OH]D_(3))and serum bilirubin(TBil)were compared between the two groups before operation and 1 day after operation,the incidence of postoperative complications in the two groups was counted.Results The total effective rate of treatment in the observation group was higher than that in the control group,and the total incidence of complications was lower than that in the control group,the differences were statistically significant(P<0.05).The serum 25(OH)D_(3) and TBil levels of the two groups after operation were lower than those before operation,after operation,the serum 25(OH)D_(3) level in the observation group was higher than that in the control group,while the TBil level was lower than that in the control group,the differences were statistically significant(P<0.05).Conclusion Laparoscopic CME has better curative effect in the treatment of CC,which can effectively improve the hepatointestinal circulation and has lower incidence of postoperative complications,and can provide the basis for drug selection in the short-term nutrition after operation and immunotherapy.