HALS与LAP用于直肠癌根治术患者的临床疗效及其对血清炎性因子水平的影响

Effect of HALS and LAP on the Efficacy and Serum Inflammatory Factors Levels in Patients Undergoing Laparoscopic Radical Resection of Rectal Cancer

目的:探讨手辅助腹腔镜手术(hand-assisted laparoscopic surgery,HALS)与全腹腔镜手术(laparoscopic surgery,LAP)用于直肠癌根治术患者的临床疗效及其对血清炎性因子水平的影响。方法:选取2013年3月～2018年3月在我院行直肠癌根治术的患者61例进行回顾性分析,按照手术方式不同分为手辅助腹腔镜手术组(HALS组)和全腹腔镜手术组(LAP组)。比较两组患者的手术相关指标、术后恢复指标和治疗前后血清炎性因子水平的变化。结果:HALS组的手术时间、术中出血量和副损伤显著低于LAP组(P<0.05),两组中转开腹率相比无统计学差异(P>0.05);两组患者术后肠功能恢复时间、进食时间、下床时间和住院时间比较均无显著性差异(P>0.05);两组患者术后1 h和术后1 d血清白细胞介素-10(interleukin-10, IL-10)、C-反应蛋白(C reactive protein,CRP)和α肿瘤坏死因子(Tumor Necrosis Factor-α,TNF-α)水平均较术前显著升高,且HALS组显著低于LAP组(P<0.05),术后1 w血清IL-10、CRP和TNF-α水平与术前相比无统计学差异(P>0.05)。结论:HALS直肠癌根治术对患者的手术创伤小,炎性反应轻,且不影响患者的预后,利于患者的康复。

Objective: To investigate the effects of hand-assisted laparoscopic surgery(HALS) and laparoscopic surgery(LAP) on the inflammatory factors in patients undergoing laparoscopic radical resection of rectal cancer. Methods: 61 patients with rectal cancer who underwent radical resection in our hospital from March 2013 to March 2018 were retrospectively analyzed. They were divided into hand-assisted laparoscopic surgery group(HALS group) and total laparoscopic surgery group(LAP group). The operation related index,postoperative recovery index and inflammatory factor level of the two groups were compared. Results: The operation time, intraoperative bleeding volume and side injury in HALS group were significantly lower than those in LAP group(P<0.05), and there was no significant difference in the conversion rate between the two groups(P>0.05). There was no significant difference in bowel function recovery time,food intake time, out of bed time and hospitalization time between the two groups(P>0.05). The levels of interleukin-10(IL-10), C reactive protein(CRP) and Tumor Necrosis Factor-α(TNF-α) in HALS group were significantly higher than those in LAP group at 1 hour and 1 day after operation(P<0.05). There was no significant difference in serum IL-10, CRP and TNF-α at 1 week after operation between the two groups(P>0.05). Conclusion: HALS radical resection of rectal cancer has less trauma, mild inflammatory reaction, and does not affect the prognosis of patients, is conducive to the rehabilitation of patients.