减孔腹腔镜下乙状结肠及直肠上段癌根治术的临床疗效观察

Efficacy and follow-up analysis of laparoscopic radical resection of sigmoid or upper rectal cancer

目的分析减孔腹腔镜下乙状结肠及直肠上段癌根治术的临床疗效。方法选取2018年6月至2020年6月南京医科大学附属南京医院(南京市第一医院)收治的乙状结肠及直肠上段癌患者152例,采用随机数字表法分为对照组和观察组,每组76例。对照组接受常规腹腔镜手术治疗,观察组接受减孔腹腔镜手术治疗。比较两组患者的术中指标、术后指标、清扫淋巴结数、阳性淋巴结数、并发症发生情况及术后随访结果。结果观察组手术时间、总切口长度、术后疼痛评分低于对照组,差异均有显著性(P<0.05);两组清扫淋巴结数比较差异无显著性(P>0.05),而观察组检出的阳性淋巴结数明显多于对照组,差异有显著性(P<0.05)。两组术中出血量、切除肠管长度、排气时间、下床时间、住院时间、住院费用及术后并发症发生率比较差异均无显著性(P>0.05)。术后随访9~33个月,对照组局部复发2例、远处转移2例,观察组局部复发1例、远处转移2例,随访期间患者均未发生死亡。结论采用减孔腹腔镜或常规腹腔镜行乙状结肠癌及直肠上段癌根治术均可取得较好的临床疗效,且减孔腹腔镜手术可缩短手术时间、减轻术后疼痛,值得临床应用。

Objective To analyze the clinical efficacy and follow-up results of laparoscopic resection of sigmoid colon and upper rectal carcinoma.Method A total of 152 patients with sigmoid colon or upper rectal cancer admitted to our hospital from June 2018 to June 2020 were randomly selected and divided into the control group(conventional laparoscopic surgery)and the observation group(subtracting laparoscopic surgery)by random number table method.Intraoperative indicators,postoperative indicators,pain self-score indicators,surgical complications,local recurrence,metastasis and patient survival rates were compared between the two groups.Result The total incision length in the observation group was(7.0±0.7)cm,the operation time was(125.8±16.7)min,and the postoperative pain score was(1.7±0.6)points,while the control group was(9.5±0.8)cm,(136.4±19.6)min and(2.4±0.8)points,respectively.There were statistically significant differences between the two groups(P<0.05).There was no significant difference in the number of lymph nodes detected between the two groups(P>0.05),but the number of lymph nodes dissected in the observation group was significantly higher than that in the control group(P<0.05).There were no significant differences between the two groups in intraoperative bleeding,length of bowel resection,time of anal exhaust,time of getting out of bed,length of stay and cost,number of lymph nodes detected,complications and follow-up indicators(P>0.05).Conclusion The curative effect of laparoscopic radical resection for sigmoid colon cancer or upper rectal cancer is better than that of the conventional laparoscopic group,which can help relieve postoperative pain of patients,and is beneficial to the aesthetic appearance of the postoperative skin.