尾侧中间联合入路在腹腔镜结肠癌完整结肠系膜切除术患者中的应用效果

Application effects of caudal combined intermediate approach in laparoscopic complete mesocolic excision for colon cancer patients

目的:观察尾侧中间联合入路在腹腔镜结肠癌完整结肠系膜切除术患者中的应用效果。方法:回顾性分析2020年1月至2021年12月该院收治的60例右半结肠癌并不完全性肠梗阻患者的临床资料,根据手术入路不同将其分为对照组和研究组各30例。两组均行腹腔镜结肠癌完整结肠系膜切除术治疗,对照组采用头侧中间联合入路,研究组采用尾侧中间联合入路,两组术后均随访1年。比较两组手术相关指标(手术时间、术中出血量、排便时间、排气时间、术后住院时间)水平,手术前后应激指标[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)]水平、炎性指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平、肿瘤标志物[癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)]水平,并发症发生率和1年生存率。结果:研究组手术时间、排便时间、排气时间、术后住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后1 d,研究组ACTH、Cor、NE、E、CRP、TNF-α、IL-6水平均低于对照组,差异有统计学意义(P<0.05);术后3d,研究组CEA、CA125、CA19-9水平均低于对照组,差异有统计学意义(P<0.05);两组并发症发生率和1年生存率比较,差异均无统计学意义(P>0.05)。结论:尾侧中间联合入路应用于腹腔镜结肠癌完整结肠系膜切除术患者可改善手术相关指标水平,降低术后应激指标、炎性指标和肿瘤标志物水平,效果优于头侧中间联合入路。

Objective:To observe application effects of caudal combined intermediate approach in laparoscopic complete mesocolic excision for colon cancer patients.Methods:The clinical data of 60 patients with right colon cancer and incomplete intestinal obstruction admitted to this hospital from January 2020 to December 2021 were retrospectively analyzed.According to the different surgical approaches,they were divided into control group and study group,30 cases in each group.Both groups were treated with laparoscopic complete mesocolic excision for colon cancer.The control group was treated with the cranial combined intermediate approach,while the study group was treated with the caudal combined intermediate approach.Both groups were followed up for 1 year.The levels of operation-related indicators(operation time,intraoperative blood loss,defecation time,exhaust time,postoperative hospitalization time),stress indicators[adrenocorticotropic hormone(ACTH),cortisol(Cor),norepinephrine(NE),epinephrine(E)],inflammatory indicators[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)],tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),carbohydrate antigen 19-9(CA19-9)]before and after the surgery,the incidence of complications,and the 1-year survival rate were compared between the two groups.Results:The operation time,the defecation time,the exhaust time and the postoperative hospitalization time of the study group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant(P<0.05).One day after the surgery,the levels of ACTH,Cor,NE,E,CRP,TNF-αand IL-6 in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Three days after the surgery,the levels of CEA,CA125 and CA19-9 in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).However,there were no significant differences in the incidence of complications and the 1-year survival rate between the two groups(P>0.05).Conclusions:The caudal combined intermediate approach in the patients with laparoscopic complete mesocolic excision of colon cancer can improve the levels of operation-related indicators and reduce the levels of postoperative stress indicators,inflammatory indicators and tumor markers.Moreover,it is superior to the cranial combined intermediate approach.