摘要
目的比较两孔与四孔腹腔镜结直肠癌(CRC)根治术对CRC患者的疗效。方法回顾性分析262例CRC患者,按照手术方法分为两孔组(120例)和四孔组(142例)。四孔组采用四孔腹腔镜根治术(FLAC)进行治疗,两孔组采用两孔腹腔镜根治术(TLAC)治疗,观察两组围手术期临床指标、手术后疼痛程度、胃肠功能指标、免疫功能指标、肿瘤标志物以及术后并发症发生情况。结果两组手术时间无明显差异(t=1.80,P>0.05);两孔组手术失血量明显少于四孔组,腹部切口总长度、住院时间、肛门排气时间和腹胀持续时间明显短于四孔组(t分别=2.80、19.76、15.15、10.10、4.89,P均<0.05)。两孔组手术后12、24、48、72 h的VAS评分均明显低于四孔组(t分别=2.68、5.73、9.26、7.62,P均<0.05)。手术后,两孔组胃动素、胃泌素、CD3+和CD4+水平高于四孔组(t分别=22.39、17.62、8.75、12.17,P均<0.05);CD8+及癌胚抗原(CEA)、可溶性细胞角蛋白19片段(Cyfra 21-1)和糖类抗原125(CA125)水平低于四孔组(t分别=-9.07、5.40、6.28、7.73,P均<0.05)。两孔组并发症总发生率明显低于四孔组(χ^(2)=5.62,P<0.05)。结论相比FLAC,TLAC治疗CRC更能降低术中出血量,缩短腹部切口长度和住院时间,有效减轻患者疼痛程度,改善肠胃功能和免疫功能,降低体内肿瘤标志物水平,减少术后并发症发生。
Objective To compare the curative effect of two-port and four-port laparoscopic radical resection in patients with colorectal cancer(CRC).Methods A total of 262 patients with CRC were retrospectively analyzed.According to different surgical methods,they were divided into two-port group(120 cases)and four-port groups(142 cases).The four-port group underwent four port laparoscopic assisted colorectomy(FLAC),while two-port group underwent two port laparoscopic assisted colorectomy(TLAC).The perioperative indexes,postoperative pain degree,gastrointestinal function indexes,immune function indexes,tumor markers,and the occurrence of postoperative complications in the two groups were observed.Results There was no significant difference in operation time between the two groups(t=1.80,P>0.05).The intraoperative blood loss in two-port group was significantly less than that in four-port group,total length of abdominal incision,hospitalization time,anal exhaust time and duration of abdominal distension were significantly shorter than those in four-port group(t=2.80,19.76,15.15,10.40,4.89,P<0.05).At 12,24,48,72 hours after surgery,VAS scores in two-port group were significantly lower than those in four-port group(t=2.68,5.73,9.26,7.62,P<0.05).After surgery,the levels of motilin,gastrin,CD3+and CD4+in two-port group were higher than those in four-port group(t=22.39,17.62,8.75,12.17,P<0.05),while levels of CD8+,CEA,Cyfra 21-1,and CA125 were lower than those in fourport group(t=-9.07,5.40,6.28,7.73,P<0.05).The total incidence of complications in two-port group was significantly lower than that in four-port group(χ^(2)=5.62,P<0.05).Conclusion Compared with FLAC,TLAC can reduce intraoperative blood loss,shorten abdominal incision length and hospitalization time in CRC patients,which can also effectively relieve pain,improve gastrointestinal function and immune function,decrease levels of tumor markers and reduce the postoperative complications.
作者
李峻峰
孙勤丰
焦裕荣
吕伟光
LI Junfeng;SUN Qinfeng;JIAO Yurong(Department of General Surgery,Haiyan County People's Hospital,Haiyan 314300,China)
出处
《全科医学临床与教育》
2024年第6期525-529,共5页
Clinical Education of General Practice
关键词
两孔腹腔镜
四孔腹腔镜
结直肠癌
术中出血量
疼痛程度
免疫功能
two-port laparoscope
four-port laparoscope
colorectal cancer
intraoperative blood loss
pain degree
immune function
