完整结肠系膜切除术在老年结肠癌患者治疗中的有效性和安全性分析

Effectiveness and safety of complete mesenterectomy in the treatment of elderly patients with colon cancer

目的 探讨老年结肠癌患者实施完整结肠系膜切除术治疗的有效性和安全性。方法 80例老年结肠癌患者,根据手术方法不同分为对照组和研究组,每组40例。对照组患者采用传统结肠癌根治术治疗,研究组患者采用完整结肠系膜切除术治疗。对比两组手术情况,术后恢复时间,术后疼痛评分和血清炎症因子,术后并发症发生情况,术后1、2年存活率、复发率及存活患者的生活质量评分。结果 研究组淋巴结清扫数量(19.91±3.74)枚多于对照组的(15.48±3.05)枚,术中出血量(69.37±20.45)ml少于对照组的(182.65±47.92)ml,差异具有统计学意义(P<0.05)。研究组术后首次进食时间、首次排气时间、卧床时间及住院时间分别为(53.68±4.91)h、(50.32±4.45)h、(4.50±0.97)d、(10.65±1.18)d,均短于对照组的(64.27±6.84)h、(56.49±5.26)h、(5.78±1.03)d、(12.34±1.42)d,差异具有统计学意义(P<0.05)。术后第1、2、3天,研究组视觉模拟评分法(VAS)评分分别为(4.46±1.21)、(3.85±1.16)、(3.37±0.82)分,均低于对照组的(7.52±1.67)、(6.94±1.41)、(6.15±1.38)分,差异具有统计学意义(P<0.05)。术后第1、2、3天,研究组血清C反应蛋白、白细胞介素-6水平均低于对照组,差异具有统计学意义(P<0.05)。研究组术后并发症发生率为2.50%,低于对照组的15.00%,差异具有统计学意义(P<0.05)。术后1、2年,研究组存活率97.50%、92.50%高于对照组的85.00%、15.00%,复发率2.50%、10.00%低于对照组的15.00%、30.00%,差异具有统计学意义(P<0.05)。术后1、2年,研究组存活患者的生理、心理、环境、社会关系评分均高于对照组,差异具有统计学意义(P<0.05)。结论 对于老年结肠癌患者,相比传统手术,完全结肠系膜切除术具有减少术中出血量、免疫功能损害,减轻术后疼痛感,降低术后并发症风险等优势,可加快术后康复进展,还可更加彻底地清扫淋巴结,减少复发,提升远期存活率,使患者在存活期间的生活质量得到显著改善,值得推广应用。

Objective To discuss the effectiveness and safety of complete mesenterectomy in the treatment of elderly patients with colon cancer. Methods A total of 80 elderly patients with colon cancer were divided into control group and research group according to different surgical methods, with 40 cases in each group.Patients in the control group were treated with conventional radical resection of colon cancer, while patients in the research group were treated with complete mesenterectomy. Both groups were compared in terms of surgical conditions, postoperative recovery time, postoperative pain score, serum inflammatory factors, occurrence of postoperative complications, survival rate at 1 and 2 years postoperatively, recurrence rate and quality of life score of the surviving patients. Results The number of lymph node dissection in the research group was(19.91±3.74) nodes, which was more than(15.48±3.05) nodes in the control group;the intraoperative blood loss in the research group was(69.37±20.45) ml, which was less than(182.65±47.92) ml in the control group;the differences were statistically significant(P<0.05). The postoperative first eating time, first exhaust time, bed time and hospitalization time in the research group were(53.68±4.91) h,(50.32±4.45) h,(4.50±0.97) d and(10.65±1.18) d, which were shorter than(64.27±6.84) h,(56.49±5.26) h,(5.78±1.03) d and(12.34±1.42) d in the control group, and the differences were statistically significant(P<0.05). At 1, 2 and 3 d postoperatively, the visual analogue scale(VAS) scores of the research group were(4.46±1.21),(3.85±1.16) and(3.37±0.82) points,which were lower than(7.52±1.67),(6.94±1.41) and(6.15±1.38) points of the control group, and the differences were statistically significant(P<0.05). At 1, 2 and 3 d postoperatively, the levels of serum C-reactive protein and interleukin-6 in the research group were lower than those in the control group, and the differences were statistically significant(P<0.05). The incidence of postoperative complications in the research group was 2.50%, which was lower than 15.00% in the control group, and the difference was statistically significant(P<0.05). At 1 and 2 years postoperatively, the survival rate of the research group were 97.50% and 92.50%, which were higher than 85.00%and 15.00% of the control group;the recurrence rate of the research group were 2.50% and 10.00%, which were lower than 15.00% and 30.00% of the control group;the differences were statistically significant(P<0.05). At 1 and 2 years postoperatively, the scores of physiological, psychological, environmental and social relations of the surviving patients in the research group were higher than those in the control group, and the differences were statistically significant(P<0.05). Conclusion For elderly patients with colon cancer, compared with conventional surgery, complete mesocolectomy has the advantages of reducing intraoperative blood loss and immune function damage, relieving postoperative pain, reducing the risk of postoperative complications. It can accelerate the progress of postoperative recovery, as well as clear lymph nodes more thoroughly, reduce recurrence and improve long-term survival rate, resulting in significant improvement of patients’ quality of life during survival, which is worthy of promotion and application.