摘要
目的:探讨不同腹腔镜手术(两孔法与四孔法)治疗结直肠癌的效果。方法:回顾性分析2021年8月—2023年3月麻城市中医医院普外科收治的102例结直肠癌患者的临床资料,按照手术方式的不同将患者分为两孔组(n=52)和四孔组(n=50)。比较两组短期结局、手术相关指标、术前及术后3 d炎症反应[C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin 6,IL-6)及肿瘤细胞坏死因子-α(tumor necrosis factor-α,TNF-α)]及免疫功能(CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)),并记录术后并发症情况。结果:102例患者术后30 d均无再手术病例,未见肿瘤复发或转移,围手术期无死亡病例。两组保肛率、中转开腹率、淋巴结清扫数、环切缘阳性率、术后30 d再返院率及系膜完整性比较,差异无统计学意义(P>0.05)。两孔组切口总长度、术后住院时间、首次排气时间及首次下床时间短于四孔组,差异有统计学意义(P<0.05);两组手术时间、术中出血量比较,差异无统计学意义(P>0.05)。术后3 d,两组CRP、IL-6及TNF-α水平较术前升高,但两孔组低于四孔组,差异有统计学意义(P<0.05)。术后3 d,两组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)较术前降低,但两孔组高于四孔组,差异有统计学意义(P<0.05)。两组术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论:四孔和两孔腹腔镜均对结直肠具有较好的疗效,但两孔腹腔镜手术创伤更小、恢复更快,可降低患者炎症反应,对免疫功能影响较小。
Objective:To investigate the effect of different laparoscopic surgery(two-hole method and four-hole method)in the treatment of colorectal cancer.Method:The clinical data of 102 patients with colorectal cancer who admitted to the Department of General Surgery of Macheng Hospital of Traditional Chinese Medicine from August 2021 to March 2023 were retrospectively analyzed,the patients were divided into the two-hole group(n=52)and the four-hole group(n=50)according to different surgical methods.The shortterm outcomes,operation-related indicators,inflammatory response[C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)]and immune function(CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+))before and 3 d after operation were compared the two groups,and the complications after operation were recorded.Result:Among 102 patients,there was no reoperation 30 d after operation,no tumor recurrence or metastasis,and no death during the perioperative period.There were no significant differences in the anal preservation rate,conversion rate to laparotomy,number of lymph node dissection,positive rate of circumferential resection margin,rate of return to hospital 30 d after operation and mesangial integrity between two groups(P>0.05).The total length of incision,postoperative hospital stay,first exhaust time and first out of bed time in the two-hole group were shorter than those in the four-hole group(P<0.05);there were no significant differences in the operation time and intraoperative blood loss between two groups(P>0.05).At 3 d after operation,the levels of CRP,IL-6 and TNF-αin two groups were increased compared with those before operation,but which in the two-hole group were lower than those in the four-hole group,the differences were statistically significant(P<0.05).At 3 d after operation,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in both groups were decreased compared with those before operation,but which in the two-hole group were higher than those in the fourhole group,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of postoperative complications between two groups(P>0.05).Conclusion:Both four-hole and two-hole laparoscopy have good effects on colorectal cancer,but two-hole laparoscopy has the advantages of less trauma and faster recovery,it can reduce the inflammatory response and has little effect on immune function.
作者
李光华
赵小平
LI Guanghua;ZHAO Xiaoping(Macheng Hospital of Traditional Chinese Medicine,Macheng 438399,China;不详)
出处
《中外医学研究》
2024年第14期114-118,共5页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
结直肠癌
两孔腹腔镜
四孔腹腔镜
疗效
炎症反应
免疫功能
Colorectal cancer
Two-hole laparoscopy
Four-hole laparoscopy
Curative effect
Inflammatory response
Immune function
