腹腔镜根治术对结直肠癌患者近期预后及生存质量的影响分析

Effect of laparoscopic radical resection on short-term prognosis and quality of life in patients with colorectal cancer

目的通过对腹腔镜根治术治疗结直肠癌患者的回顾性研究,探讨腹腔镜根治术对结直肠癌患者近期预后及生存质量的影响。方法选取2020-09-19-2021-09-01信阳市中心医院结直肠癌患者98例,采用回顾性病例对照研究方法,随机分为观察组49例与对照组49例。观察组患者行腹腔镜根治术治疗,对照组患者行开腹手术治疗。比较2组围术期指标变化,术后并发症,胃肠道恢复情况,术前和术后3d应激反应指标变化,随访12个月生存质量改善情况以及12个月近期预后情况。结果观察组出血量(51.38±10.28)mL少于对照组(127.19±25.46)mL,观察组切口长度(4.87±0.32)cm小于对照组(18.47±3.24)cm,而观察组手术时间(180.39±15.46)min短于对照组(214.34±13.24)min,差异有统计学意义,t值分别为19.327、29.240和11.676,均P<0.001。观察组并发症发生5例(10.20%)少于对照组11例(28.57%),差异有统计学意义,χ^(2)=5.289,P=0.021。观察组排气时间(2.45±0.51)d、进食时间(48.98±12.38)h和肠鸣音恢复时间(2.67±0.37)d快于对照组排气时间(3.78±0.72)d、进食时间(95.64±24.15)h和肠鸣音恢复时间(3.81±0.54)d,差异有统计学意义,t值分别为10.552、12.035和12.191,均P<0.001。2组术后3d观察组血清肿瘤坏死因子-α(TNF-α;t=8.595)、皮质醇(Cor;t=6.712)和白介素-6(IL-6;t=6.190)水平以及对照组血清TNF-α(t=17.135)、Cor(t=20.192)和IL-6(t=17.271)水平均较术前升高,差异有统计学意义,均P<0.05;观察组术后3d血清TNF-α(t=10.024)、Cor(t=16.005)和IL-6(t=12.923)水平低于对照组,差异有统计学意义,均P<0.001。观察组随访12个月KPS评分(81.45±4.61)分高于对照组(67.20±6.97)分,差异有统计学意义,t=11.937,P<0.05。观察组随访12个月生存患者47例(95.92%)高于对照组40例(81.63%),差异有统计学意义,χ^(2)=5.018,P<0.05。结论腹腔镜根治术对结直肠癌患者近期预后良好,且可改善患者生存质量。

Objective A retrospective study was conducted to explore the impact of laparoscopic radical surgery on the short-term prognosis and quality of life of colorectal cancer patients.Methods A retrospective case-control study was conducted on 98patients with colorectal cancer at Xinyang Central Hospital from September 19,2020to September 1,2021.The study was randomly divided into an observation group of 49cases and a control group of 49cases.The observation group patients underwent laparoscopic radical surgery,while the control group patients underwent open surgery.We compared the changes in perioperative indicators,postoperative complications,gastrointestinal recovery,changes in stress response indicators before and 3days after surgery,improvement in quality of life at 12months of follow-up,and recent prognosis at 12months between the two groups.Results The results showed that the bleeding volume in the observation group(51.38±10.28)ml was less than that in the control group(127.19±25.46)ml,the incision length in the observation group(4.87±0.32)cm was less than that in the control group(18.47±3.24)cm,and the surgical time in the observation group(180.39±15.46)min was shorter than that in the control group(214.34±13.24)min,with statistically significant differences(t=19.327,29.240,11.676,P<0.05).There were 5cases(10.20%)of complications in the observation group compared to 11cases(28.57%)in the control group,and the difference was statistically significant(χ^(2)=5.289,P<0.05).The observation group had a faster exhaust time(2.45±0.51)days,eating time(48.98±12.38)hours,and bowel sound recovery time(2.67±0.37)days than the control group's exhaust time(3.78±0.72)days,eating time(95.64±24.15)hours,and bowel sound recovery time(3.81±0.54)days,with statistically significant differences(t=10.552,12.035,12.191,P<0.05).Two groups of postoperative serum TNF-αin the observation group 3days after surgery(t=8.595),Cor(t=6.712),and IL-6(t=6.190)levels,as well as serum TNF-αlevels(t=17.135)in the control group,the levels of,Cor(t=20.192),and IL-6(t=17.271)were all higher than before surgery,and the differences were statistically significant(P<0.05);Observation group:Serum TNF-α(t=10.024).the levels of,Cor(t=16.005),and IL-6(t=12.923)3days after surgery were lower than those of the control group,and the differences were statistically significant(all P<0.05).The KPS score of the observation group(81.45±4.61)was higher than that of the control group(67.20±6.97)after 12months of follow-up,and the difference was statistically significant(t=11.937,P<0.05).There were 47patients(95.92%)in the observation group who survived for 12months,higher than 40patients(81.63%)in the control group,with a statistically significant difference(χ^(2)=5.018,P<0.05).Conclusion Laparoscopic radical surgery has a good short-term prognosis for colorectal cancer patients and can improve their quality of life.