腹腔镜TME对中低位直肠癌患者术后胃肠功能的影响

Effect of Laparoscopic TME on Postoperative Gastrointestinal Function in Patients with Low and Middle Rectal Cancer

目的:探讨腹腔镜全直肠系膜切除术(TME)对中低位直肠癌患者术后胃肠功能的影响。方法:选择2016年1月-2021年6月于中国人民解放军联勤保障部队第九四〇医院和兰州市第二人民医院行择期手术治疗的120例中低位直肠癌患者作为研究对象,随机分成观察组(n=60)与对照组(n=60)。其中观察组择期行腹腔镜TME治疗,而对照组择期行传统开腹TME治疗。比较两组手术一般情况及术后胃肠功能恢复情况。手术前后检测两组血清胃肠激素[胃泌素(GAS)、胃动素(MTL)]水平。结果:观察组手术时间较对照组显著长(P<0.05),但术中出血量、术后24 h时疼痛视觉模拟量表(VAS)评分、术后留置尿管时间、切口愈合时间、术后住院时间均显著优于对照组(P<0.05)。观察组保肛率为73.33%(44/60),与对照组的58.33%(35/60)比较显著高(P<0.05)。观察组术后并发症率为5.00%(3/60),与对照组的21.67%(13/60)相比显著低(P<0.05)。两组肿瘤下缘距远切缘距离、淋巴结清扫数目对比差异均无统计学意义(P>0.05)。观察组术后(肠蠕动)肠鸣音恢复时间及术后首次肛门排气时间、进食时间和排便时间均显著早于对照组(P<0.05)。两组术后第3天时血清GAS、MTL浓度均较本组术前显著降低(P<0.05),且对照组下降更显著(P<0.05)。结论:应用腹腔镜TME治疗中低位直肠癌能有效减轻对患者术后胃肠功能的不良影响。

Objective:To investigate the effect of laparoscopic total mesorectal excision(TME)on gastrointestinal function in patients with middle and low rectal cancer.Method:A total of 120 patients with middle and low rectal cancer who underwent elective surgery in the 940th Hospital of the PLA Joint Logistics Support Force and the Second People’s Hospital of Lanzhou from January 2016 to June 2021 were selected for the study,the patients were randomly divided into observation group(n=60)and control group(n=60).The observation group was treated with laparoscopic TME,while the control group was treated with traditional open TME.The general condition of operation and the recovery of gastrointestinal function were compared between the two groups.The levels of serum gastrin(GAS)and motilin(MTL)were measured before and after operation.Result:The operation time of observation group was significantly longer than that of control group(P<0.05),but the amount of bleeding during operation,visual analogue scale(VAS)score at 24 h after operation,the time of indwelling catheter,incision healing and hospital stay after operation were significantly better than those of the control group(P<0.05).The anal preservation rate of the observation group was 73.33%(44/60),which was significantly higher than 58.33%(35/60)of the control group(P<0.05).The postoperative complication rate of the observation group was 5.00%(3/60),which was significantly lower than 21.67%(13/60)of the control group(P<0.05).There were no significant differences in the distance between the lower margin of tumor and the distal resection margin and the number of dissected lymph nodes between the two groups(P>0.05).The recovery time of bowel sounds,the first anal exhaust time,the time of feeding and the time of defecation in the observation group were significantly earlier than those in the control group(P<0.05).The serum concentrations of GAS and MTL in both groups on the third day after surgery were significantly lower than those before surgery(P<0.05),and the decrease were more significant in the control group(P<0.05).Conclusion:Laparoscopic TME in the treatment of low and middle rectal cancer can effectively reduce the postoperative gastrointestinal function of patients with adverse effects.