腹腔镜手术与开腹手术对结肠癌患者创伤应激及预后的影响

doi:10.3969/j.issn.1006-6233.2020.05.028

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摘要 目的:分析腹腔镜手术与开腹手术对结肠癌患者创伤应激及预后的影响。方法:选取医院2012年8月至2015年3月收治的96例结直肠癌患者进行研究,按简单随机分组法分为微创组(腹腔镜手术)与开腹组(开腹手术),比较两组患者手术相关指标、创伤应激指标、并发症及预后相关指标。结果:微创组术中出血量低于开腹组,切口长度短于开腹组,肛门恢复排气时间早于开腹组,差异均有统计学意义(P<0.05)。两组患者手术时间、淋巴结清扫数及住院时间比较差异无统计学意义(P>0.05)。术后1d、3d、5d时微创组醛固酮、皮质醇及肾上腺素水平均低于开腹组,差异有统计学意义(P<0.05)。两组患者并发症总发生率及不同类型并发症发生率比较差异均无统计学意义(P>0.05)。其中开腹组1例吻合口瘘及2例肠梗阻经手术治愈,其余并发症采用保守治疗后好转。两组患者随访时间比较差异无统计学意义(P>0.05),微创组5例患者失访,开腹组9例患者失访。两组患者5年局部复发率、远处转移率、总体生存率及无瘤生存率比较差异均无统计学意义(P>0.05)。结论:腹腔镜手术治疗结肠癌预后与开腹手术相近,但手术导致的创伤应激较小。

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关键词 ：结肠癌, 开腹手术, 腹腔镜手术, 根治术, 预后, 创伤, 应激反应

Abstract：Objective: To analyze the influence of laparoscopy and laparotomy on the trauma stress and prognosis of colon cancer patients. Methods: 96 patients with colorectal cancer admitted to the hospital from August 2012 to March 2015 were selected for study. They were divided into minimally invasive group (laparoscopic surgery)and open surgery group(open surgery) according to simple random grouping method. The operation related indexes, trauma stress indexes, complications and prognosis related indexes of the two groups were compared. Results: In the minimally invasive group, the bleeding volume was lower than that in the open group, the incision length was shorter than that in the open group, and the anal recovery time was earlier than that in the open group (P<0.05). There was no significant difference between the two groups in operation time, lymphadenectomy and hospitalization time (P>0.05). The levels of aldosterone, cortisol and adrenaline in the minimally invasive group were lower than those in the open group on the 1st, 3rd and 5th day after operation (P<0.05). There was no significant difference in the total incidence of complications and the incidence of different types of complications between the two groups (P>0.05). One case of anastomotic leakage and two cases of intestinal obstruction in the open group were cured by operation, and the other complications improved after conservative treatment. There was no significant difference in the follow-up time between the two groups (P>0.05), 5 patients in the minimally invasive group lost the visit, 9 patients in the open group lost the visit. There was no significant difference in 5-year local recurrence rate, distant metastasis rate, overall survival rate and tumor free survival rate between the two groups (P>0.05). Conclusion: The prognosis of laparoscopic surgery for colon cancer is similar to that of open surgery, but the trauma stress caused by surgery is less

Key words： Colon cancer Laparotomy Laparoscopic surgery Radical surgery Prognosis Trauma Stress response

基金资助:四川省卫生和计划生育科研课题,(编号:17PJ038)

通讯作者: 肖江卫

引用本文:

田彬, 肖江卫, 申伟文, 王绍华, 李洋. 腹腔镜手术与开腹手术对结肠癌患者创伤应激及预后的影响[J]. 河北医学, 2020, 26(5): 815-819.
TIAN Bin, et al. The Influence of Laparoscopy and Laparotomy on the Trauma Stress and Prognosis of Colon Cancer Patients. HeBei Med, 2020, 26(5): 815-819.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.05.028 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I5/815

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