腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌的临床效果

Clinical effect of laparoscopic total mesocolectomy combined with mesenteric vascular root ligation in the treatment of right colon cancer

目的探究腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌的临床效果。方法回顾性选取于2015年5月至2017年3月在西京医院消化外科接受根治治疗的右半结肠癌患者80例,根据术式不同分为观察组、对照组,各40例。对照组接受开腹全结肠系膜切除术治疗,观察组接受腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗。对比两组围术期指标及术前、术后1 d T淋巴细胞亚群、血清炎症指标水平,评估两组术后总并发症发生率、术后3年局部复发率及存活率。结果观察组手术时间、术中出血量、切口长度、术后肛门排气时间及术后住院时间均明显少于对照组,清扫淋巴结数目明显多于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组患者CD4^(+)含量和CD4^(+)/CD8^(+)比率均较治术前降低,差异均有统计学意义(P<0.05),而两组术后1 d与术前相比以及两组间术后1 d比较CD8^(+)含量差异均无统计学意义(P>0.05);观察组术后1 d CD4^(+)含量和CD4^(+)/CD8^(+)比率明显高于对照组,差异均有统计学意义(P<0.05)。术后1 d,两组患者血清IL-6、HMGB1水平均比术前升高,但观察组血清IL-6、HMGB1水平明显低于对照组,差异均有统计学意义(P<0.05)。观察组术后总并发症发生率(5.00%)远低于对照组(22.50%),差异有统计学意义(P<0.05)。观察组术后3年局部复发率(17.50%)远低于对照组(40.00%),存活率(65.00%)远高于对照组(42.50%),差异有统计学意义(P<0.05)。结论腹腔镜下全结肠系膜切除术联合肠系膜血管根部结扎治疗右半结肠癌术后恢复快,可明显减轻机体炎症反应,且对机体免疫功能损伤小,并发症少,远期效果可观。

Objective To explore the clinical effect of laparoscopic total mesocolectomy combined with mesenteric vascular root ligation in the treatment of right colon cancer.Methods From May 2015 to March 2017,80 patients with right colon cancer who received radical treatment in Department of Digestive Surgery of Xijing Hospital were retrospectively selected.According to the different operation methods,they were divided into two groups:observation group and control group,each group had 40 cases.The control group received open total mesocolectomy,the observation group received laparoscopic total mesocolectomy combined with mesenteric vascular root ligation.The perioperative indexes,T-lymphocyte subsets and serum inflammatory indexes on before operation and 1 d after operation were compared between the two groups,and the incidence of postoperative total complications,local recurrence rate and survival rate on 3 years after operation were evaluated.Results The operation time,intraoperative bleeding volume,incision length,postoperative anal exhaust time and postoperative hospital stay in the observation group were significantly less than those in the control group,and the number of lymph nodes was significantly more than that in the control group,the differences were statistically significant(P<0.05).At 1 day after operation,the CD4^(+)content and CD4^(+)/CD8^(+)in the two groups were lower than those before the operation,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the content of CD8^(+)within and between the two groups(P>0.05).At 1 day after operation,the CD4^(+)content and CD4^(+)/CD8^(+)in the observation group were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).At 1 day after operation,the levels of serum IL-6 and HMGB1 in the two groups were higher than those before the operation,but the levels of serum IL-6 and HMGB1 in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group(5.00%)was much lower than that in the control group(22.50%),the difference was statistically significant(P<0.05).The 3-year local recurrence rate of the observation group(17.50%)was much lower than of the control group(40.00%),and the survival rate of the observation group(65.00%)was much higher than of the control group(42.50%),the difference was statistically significant(P<0.05).Conclusion Laparoscopic total mesocolectomy combined with mesenteric vascular root ligation for the treatment of right hemicolon cancer has fast postoperative recovery,can significantly reduce the inflammatory response of the body,and has little damage to the immune function of the body,less complications,and considerable long-term effect.