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(χ2=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.
Abstract
Objective To compare the curative effect of two-port and four-port laparoscopic radical resection in pa-tients with colorectal cancer(CRC).Methods A total of 262 patients with CRC were retrospectively analyzed.Accord-ing 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 func-tion 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 four-port 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(χ2=5.62,P＜0.05).Conclusion Compared with FLAC,TLAC can reduce intraoperative blood loss,shorten abdomi-nal incision length and hospitalization time in CRC patients,which can also effectively relieve pain,im-prove gastrointestinal function and immune function,decrease levels of tumor markers and reduce the postoperative com-plications.
NETL
NSTL
万方数据