首页|单切口腹腔镜结肠癌根治术对结直肠癌患者术后生活质量和预后的影响

单切口腹腔镜结肠癌根治术对结直肠癌患者术后生活质量和预后的影响

The impact of single incision laparoscopic radical resection for colorectal cancer on postoperative quality of life and prognosis of colorectal cancer patients

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目的 探究单切口腹腔镜结肠癌根治术对结直肠癌患者术后生活质量和预后的影响.方法 前瞻性选取2019年6月至2022年6月间苏州市立医院收治的84例结直肠癌患者纳入研究,根据患者意愿分成两组,每组各42例.对照组予以传统腹腔镜结肠癌根治术;观察组予以单切口腹腔镜结肠癌根治术.比较两组手术相关指标、术后应激反应、免疫炎症反应、肿瘤标志物、并发症及预后情况.结果 与对照组相比,观察组术中出血量少[(142.58±23.76)ml vs(121.37±20.23)ml],肠道功能恢复快[(3.87±0.65)d vs(3.12±0.45)d],术后视觉模拟量表(VAS)评分低[(3.52±0.70)分 vs(2.46±0.49)分],术后并发症发生率少[26.19%(11/42)vs 7.14%(3/42)](均 P<0.05);两组手术时间、住院时间和癌胚抗原(CEA)、糖类抗原(CA199)水平比较差异无统计学意义(均 P>0.05).观察组术后皮质醇(Cor)[(473.25±52.58)nmol/L vs(447.53±49.73)nmol/L]、肾上腺素(E)[(662.41±73.60)μg/L vs(622.84±69.20)μg/L]、去甲肾上腺素(NE)[(18.52±2.06)μg/L vs(17.48±1.94)μg/L]、白细胞介素 6(IL-6)[(51.24±5.26)pg/ml vs(47.33±5.26)pg/ml]、超敏C反应蛋白(hs-CRP)[(21.47±3.58)ng/ml vs(19.26±3.21)ng/ml]水平低于对照组(均P<0.05).观察组术后CD3+[(58.34±3.89)vs(60.21±4.01)]、CD4+/CD8+[(1.24±0.14)vs(1.31±0.15)]水平高于对照组(均P<0.05).两组生存曲线分析比较差异无统计学意义(P>0.05).结论 对结直肠患者予以传统常规腹腔镜根治术和单切口腹腔镜根治术均有较好疗效,可有效降低肿瘤标志物水平,且患者均有较好预后,但单切口腹腔镜根治术对患者应激损伤较小,可减轻免疫炎症反应,且术后并发症少,能促进术后康复.
Objective To investigate the impact of single incision laparoscopic radical resection of colon cancer on postoperative quality of life and prognosis in patients with colon cancer.Methods A prospective study was conducted on 84 colorectal cancer patients admitted to Suzhou Municipal Hospital between June 2019 and June 2022.The patients were divided into two groups of 42 each according to their wishes.The control group underwent traditional laparoscopic radical surgery for colon cancer;The observation group underwent single incision laparoscopic radical resection for colon cancer.Two sets of surgical related indicators,postoperative stress response,immune inflammatory response,tumor markers,complications,and prognosis were compared.Results Compared with the control group,the observation group had less intraoperative bleeding[(142.58±23.76)ml vs(121.37±20.23)ml],faster recovery of intestinal function[(3.87±0.65)d vs(3.12±0.45)d],lower postoperative Visual Analog Scale(VAS)scores[(3.52±0.70)points vs(2.46±0.49)points],and a lower incidence of postoperative complications[26.19%(11/42)vs 7.14%(3/42)](all P<0.05);There was no statistically significant difference in the surgical time,hospitalization time,and levels of carcinoembryonic antigen(CEA)and carbohydrate antigen(CA199)between the two groups(all P>0.05).The postoperative level of cortisol(Cor)[(473.25±52.58)nmol/L vs(447.53±49.73)nmol/L],adrenaline(E)[(662.41±73.60)μg/L vs(622.84±69.20)μ g/L],norepinephrine(NE)[(18.52±2.06)μ g/L vs(17.48±1.94)μ g/L],interleukin-6(IL-6)[(51.24±5.26)pg/ml vs(47.33±5.26)pg/ml],high-sensitivity C-reactive protein(hs-CRP)[(21.47±3.58)ng/ml vs(19.26±3.26)ng/ml]of the observation group was lower than that of the control group(all P<0.05).The postoperative levels of CD3+[(58.34±3.89)vs(60.21±4.01)]and CD4+/CD8+[(1.24±0.14)vs(1.31±0.15)]in the observation group were higher than those in the control group(all P<0.05).There was no statistically significant difference in the survival curve analysis between the two groups(P>0.05).Conclusions Both traditional conventional laparoscopic radical surgery and single incision laparoscopic radical surgery have good therapeutic effects on colorectal patients,which can effectively reduce tumor marker levels and have a good prognosis.However,single incision laparoscopic radical surgery has less stress damage to patients,can reduce immune inflammatory reactions,and has fewer postoperative complications,which can promote postoperative recovery.

Colorectal neoplasmsLaparoscopyQuality of lifePrognosis

寇忠阳、苏江、袁钦华、顾晓东

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苏州市立医院胃肠外科,苏州 215000

结直肠肿瘤 腹腔镜检查 生活质量 预后

江苏省自然科学基金苏州市科技计划项目

BK20211083SYS2020178

2024

中国医师杂志
中华医学会 湖南省医学会

中国医师杂志

CSTPCD
影响因子:0.876
ISSN:1008-1372
年,卷(期):2024.26(7)