腹腔镜结肠癌全结肠系膜切除术治疗结肠癌的疗效观察

Efficacy observation of laparoscopic complete mesocolic excision for colon cancer

目的分析结肠癌患者采用腹腔镜结肠癌全结肠系膜切除术进行治疗的临床疗效。方法88例结肠癌患者,采用随机盲选法分为对照组和观察组,每组44例。对照组患者采用常规结肠癌根治术进行治疗,观察组患者采用腹腔镜结肠癌全结肠系膜切除术进行治疗。比较两组患者治疗效果、术中出血量、手术时间、淋巴结清扫数目、住院时间、术后并发症发生情况,术后生活质量、疼痛程度,手术前后应激反应指标。结果观察组患者治疗总有效率为97.73%(43/44),明显高于对照组的84.09%(37/44),差异具有统计学意义(P<0.05)。观察组患者术中出血量(118.38±3.52)ml少于对照组的(154.23±2.88)ml,手术时间(185.56±5.24)min、住院时间(10.76±2.04)d短于对照组的(214.32±3.05)min、(14.05±2.43)d,淋巴结清扫数目(25.66±2.73)个多于对照组的(16.05±1.86)个,差异具有统计学意义(P<0.05)。观察组患者术后并发症发生率为6.82%(3/44),低于对照组的22.73%(10/44),差异具有统计学意义(P<0.05)。观察组患者术后健康调查简表(SF-36)评分(79.96±2.05)分高于对照组的(70.25±1.75)分,视觉模拟评分法(VAS)评分(4.05±0.86)分低于对照组的(6.15±1.05)分,差异具有统计学意义(P<0.05)。手术后,两组患者去甲肾上腺素、肾上腺素、皮质醇水平均高于本组手术前,但观察组患者去甲肾上腺素(122.55±6.45)ng/ml、肾上腺素(112.04±6.88)ng/ml、皮质醇(164.25±4.78)ng/ml低于对照组的(205.45±5.04)、(186.52±7.85)、(243.55±6.45)ng/ml,差异具有统计学意义(P<0.05)。结论结肠癌患者采用腹腔镜结肠癌全结肠系膜切除术进行治疗效果显著,可以有效减少手术对患者造成的创伤,降低术后并发症发生率,促进术后尽快恢复,提升患者术后生活质量,值得临床推广应用。

Objective To analyze the clinical efficacy of laparoscopic complete mesocolic excision for colon cancer.Methods A total of 88 patients with colon cancer were randomly divided into control group and observation group,with 44 patients in each group.Patients in the control group were treated with conventional laparocolectomy,while patients in the observation group were treated with laparoscopic complete mesocolic excision.Both groups were compared in terms of therapeutic effect,intraoperative blood loss,operating time,number of lymph node dissection,hospital stay,occurrence of postoperative complications,postoperative quality of life,pain degree and stress response indicators before and after surgery.Results The total effective rate of treatment in the observation group was 97.73%(43/44),which was significantly higher than that of 84.09%(37/44)in the control group,and the difference was statistically significant(P<0.05).The intraoperative blood loss of(118.38±3.52)ml in the observation group was less than that of(154.23±2.88)ml in the control group;the operating time of(185.56±5.24)min and hospital stay of(10.76±2.04)d in the observation group were shorter than those of(214.32±3.05)min and(14.05±2.43)d in the control group;the number of lymph node dissection of(25.66±2.73)nodes in the observation group was more than of(16.05±1.86)nodes in the control group;the differences were statistically significant(P<0.05).The incidence of postoperative complications was 6.82%(3/44)in the observation group,which was lower than of 22.73%(10/44)in the control group,and the difference was statistically significant(P<0.05).The postoperative 36-item short-form health survey(SF-36)score of(79.96±2.05)points in the observation group was higher than that of(70.25±1.75)points in the control group,and the visual analogue scale(VAS)score of(4.05±0.86)points was lower than that of(6.15±1.05)points in the control group,and the differences were statistically significant(P<0.05).After surgery,the norepinephrine,epinephrine and cortisol levels in both groups were higher than those before surgery in this group;the observation group had norepinephrine of(122.55±6.45)ng/ml,epinephrine of(112.04±6.88)ng/ml,and cortisol of(164.25±4.78)ng/ml,which were lower than those of(205.45±5.04),(186.52±7.85),and(243.55±6.45)ng/ml in the control group;the differences were statistically significant(P<0.05).Conclusion Laparoscopic complete mesocolic excision has a significant effect on colon cancer patients,which can effectively reduce the trauma caused by surgery,reduce the incidence of postoperative complications,promote postoperative recovery as soon as possible,and improve the quality of life of patients after surgery.It is worthy of clinical promotion and application.