腹腔镜结肠癌根治术治疗结肠癌的疗效及对胃肠道功能的影响分析

Analysis of curative effect of laparoscopic radical resection for colon cancer and its influence on gastrointestinal function

目的探讨在结肠癌的治疗中采用腹腔镜手术的临床效果及对患者胃肠道功能的影响。方法选取58例结肠癌患者,采用随机数字表法分成对照组和研究组,每组29例。对照组采用传统开放手术治疗,研究组采用腹腔镜结肠癌根治术治疗。对比两组围手术期相关指标、淋巴结清扫数量、血清炎性指标、血清应激指标及并发症发生率。结果研究组术中出血量(87.63±6.24)ml、术后引流量(24.32±2.05)ml较对照组的(122.25±9.52)、(30.23±2.63)ml少,手术时间(136.15±7.16)min、术后排气时间(3.14±0.26)d、肠鸣音恢复时间(2.34±0.43)d、恢复饮食时间(68.74±4.23)h、住院时间(10.42±1.16)d均较对照组的(141.05±8.75)min、(4.25±0.55)d、(3.58±0.75)d、(87.36±5.52)h、(15.27±1.44)d短(P<0.05)。两组肿瘤分期Ⅰ、Ⅱ期淋巴结清扫数量无显著差异(P>0.05);研究组肿瘤分期Ⅲ期淋巴结清扫数量、阳性淋巴结清扫数量、左半结肠淋巴结清扫数量、右半结肠淋巴结清扫数量分别为(25.11±2.02)、(21.06±2.14)、(18.87±1.42)、(24.23±2.14)个,均多于对照组的(17.58±1.36)、(12.25±1.23)、(16.25±1.26)、(18.54±1.52)个(P<0.05)。术后,对照组白细胞介素-6(IL-6)为(28.85±2.12)pg/ml,C反应蛋白(CRP)为(12.36±1.42)mg/L;研究组IL-6为(17.96±1.63)pg/ml,CRP为(8.64±1.15)mg/L,研究组IL-6、CRP较对照组低(P<0.05)。术后,对照组肾上腺素为(99.87±7.58)pg/ml,去甲肾上腺素为(176.52±9.36)pg/ml,皮质醇为(24.63±2.14)pg/ml;研究组肾上腺素为(64.25±4.31)pg/ml,去甲肾上腺素为(87.56±5.15)pg/ml,皮质醇为(13.54±1.63)pg/ml,两组较术前均有所升高,而研究组肾上腺素、去甲肾上腺素、皮质醇均较对照组低(P<0.05)。研究组并发症发生率(6.90%)较对照组(31.03%)低(P<0.05)。结论在结肠癌治疗中采用腹腔镜结肠癌根治术治疗可提高淋巴结清扫数量,缩短术后胃肠功能的恢复时间,改善血清炎性指标水平,减少应激反应,术后并发症发生率较低,有利于术后机体的康复,建议临床广泛应用。

Objective To explore the clinical effect of laparoscopic radical resection for colon cancer and its influence on gastrointestinal function.Methods 58 patients with colon cancer were randomly divided into a control group and a study group with 29 cases in each group.The control group was treated with traditional open surgery,and the study group was treated with laparoscopic radical resection of colon cancer.The perioperative related indicators,number of lymph node dissection,serum inflammatory indicators,serum stress indicators and complication rate were compared between the two groups.Results The intraoperative blood loss of(87.63±6.24)ml and postoperative drainage volume of(24.32±2.05)ml in the study group were less than(122.25±9.52)and(30.23±2.63)ml in the control group;the study group had operation time of(136.15±7.16)min,postoperative exhaust time of(3.14±0.26)d,bowel sound recovery time of(2.34±0.43)d,diet recovery time of(68.74±4.23)h,hospitalization time of(10.42±1.16)d,which were shorter than(141.05±8.75)min,(4.25±0.55)d,(3.58±0.75)d,(87.36±5.52)h,(15.27±1.44)d in the control group(P<0.05).There was no significant difference in the number of lymph node dissection in patients with stageⅠandⅡtumors between the two groups(P>0.05).The number of lymph node dissection,the number of positive lymph node dissection,the number of left hemicolonic lymph node dissection,and the number of right hemicolonic lymph node dissection in patients with stageⅢtumor in the study group were(25.11±2.02),(21.06±2.14),(18.87±1.42),and(24.23±2.14)nodes,which were more than(17.58±1.36),(12.25±1.23),(16.25±1.26),and(18.54±1.52)nodes in the control group(P<0.05).After surgery,the control group had interleukin-6(IL-6)of(28.85±2.12)pg/ml and C-reactive protein(CRP)of(12.36±1.42)mg/L,and the study group had IL-6 of(17.96±1.63)pg/ml and CRP of(8.64±1.15)mg/L.The levels of IL-6 and CRP in the study group were lower than those in the control group(P<0.05).After surgery,the epinephrine of the control group was(99.87±7.58)pg/ml,the norepinephrine was(176.52±9.36)pg/ml and the cortisol was(24.63±2.14)pg/ml;the epinephrine of the study group was(64.25±4.31)pg/ml,the norepinephrine was(87.56±5.15)pg/ml and the cortisol was(13.54±1.63)pg/ml.The levels of epinephrine,norepinephrine and cortisol in both groups increased,and the study group were higher than the control group(P<0.05).The incidence of complications in the study group was 6.90%,which was lower than 31.03%that in the control group(P<0.05).Conclusion In the treatment of colon cancer,laparoscopic radical resection of colon cancer can increase the number of lymph node dissection,shorten the recovery time of postoperative gastrointestinal function,improve the levels of serum inflammatory indicators and stress response,and reduce postoperative complications,which is conducive to postoperative rehabilitation of the body,so it is recommended to be widely used in clinic.