摘要
目的探究腹腔镜直肠低位前切除术治疗低位直肠癌的可行性及对患者胃肠功能、应激反应的影响。方法选取2020年3月至2022年3月上饶东信第五医院收治的60例低位直肠癌患者作为研究对象,根据手术方法不同分为研究组(n=33)与对照组(n=27)。研究组行腹腔镜直肠低位前切除术治疗,对照组行腹腔镜腹会阴联合切除术治疗。比较两组手术情况、围手术期恢复时间、围手术期并发症发生情况、应激指标[白细胞介素-6(interleukin 6,IL-6)、皮质醇(cortisol,Cor)、β-内啡肽(β-endogorphin,β-EP)]、胃肠功能[D-乳酸、二胺氧化酶(diamine oxidase,DAO)、胃动素(motilin,MTL)、胃泌素(gastrin,GAS)]水平、生命质量[欧洲癌症研究治疗组织核心生命质量调查问卷(European Organisation for Research and Treatment of Cancer core quality of life questionnaire,EORTC QLQ-C30)]评分及远期预后。结果研究组手术时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);两组淋巴结清扫数目比较差异无统计学意义。研究组首次下床活动时间、肠鸣音恢复时间、引流管拔除时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义。术后1 d,两组IL-6、Cor、β-EP水平高于术前和术后7 d,差异有统计学意义(P<0.05);术前、术后7 d,两组IL-6、Cor、β-EP水平均比较差异无统计学意义;术后1 d,研究组IL-6、Cor、β-EP水平低于对照组,差异有统计学意义(P<0.05)。术后7 d,两组MTL、GAS水平均低于术前,D-乳酸、DAO水平均高于术前,但研究组MTL、GAS水平均高于对照组,D-乳酸、DAO水平均低于对照组,差异有统计学意义(P<0.05)。术后1、3个月,两组EORTC QLQ-C30评分均高于前一时间点,且研究组高于对照组,差异有统计学意义(P<0.05)。两组转移率、复发率、死亡率比较差异无统计学意义。结论腹腔镜直肠低位前切除术可有效治疗低位直肠癌,对患者损伤应激更小,术后可更快恢复胃肠功能及生命质量,且未增加不良预后风险,具有可行性。
Objective To explore the feasibility of laparoscopic low anterior resection for low rectal cancer and its effect on gastrointestinal function and stress response.Methods 60 patients with low rectal cancer admitted to Dongxin Fifth Hospital of Shangrao from March 2020 to March 2022 were selected as the research subjects,they were divided into the study group(n=33)and the control group(n=27)according to different surgical methods.The study group was treated with laparoscopic low anterior resection of rectum,and the control group was treated with laparoscopic combined abdominoperineal resection.The operation condition,perioperative recovery time,perioperative complications,stress indicators(interleukin-6[IL-6],cortisol[Cor],β-endogorphin[β-EP]),gastrointestinal function(D-lactic acid,diamine oxidase[DAO],motilin[MTL],gastrin[GAS]),quality of life(European Organisation for Research and Treatment of Cancer core quality of life questionnaire[EORTC QLQ-C30])score and longterm prognosis were compared between the two groups.Results The operation time in the study group was shorter than that in the control group,and the intraoperative blood loss was less than that in the control group,the differences were statistically significant(P<0.05);there was no significant difference in the number of lymph node dissection between the two groups.The first ambulation time,bowel sound recovery time,drainage tube removal time and hospitalization time in the study group were shorter than those in the control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups.at 1 d after operation,the levels of IL-6,Cor andβ-EP of the two groups were higher than those before operation and 7 d after operation,and the differences were statistically significant(P<0.05);there was no significant difference in the levels of IL-6,Cor andβ-EP between the two groups before and 7 d after operation;at 1 d after operation,the levels of IL-6,Cor andβ-EP in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).After 7 d of operation,the levels of MTL and GAS of the two groups were lower than those before operation,and the levels of D-lactic acid and DAO were higher than those before operation,but the levels of MTL and GAS in the study group were higher than those in the control group,and the levels of D-lactic acid and DAO were lower than those in the control group,the differences were statistically significant(P<0.05).At 1 and 3 months after operation,the EORTC QLQ-C30 scores of the two groups were higher than those at the previous time point,and the study group was higher than the control group,the differences were statistically significant(P<0.05).There was no significant difference in metastasis rate,recurrence rate and mortality between the two groups.Conclusion Laparoscopic low anterior resection can effectively treat low rectal cancer with less traumatic stress,faster recovery of gastrointestinal function and quality of life after surgery,and does not increase the risk of adverse prognosis,which is feasible.
作者
吕君波
谭大成
张雷
LYU Junbo;TAN Dacheng;ZHANG Lei(Department of Gastrointestinal Surgery,Dongxin Fifth Hospital of Shangrao,Shangrao,Jiangxi,334000,China)
出处
《当代医学》
2024年第36期29-34,共6页
Contemporary Medicine
关键词
腹腔镜直肠低位前切除术
腹腔镜腹会阴联合切除术
低位直肠癌
胃肠功能
手术应激
生命质量
预后
Laparoscopic low anterior resection
Laparoscopic combined abdominoperineal resection
Low rectal cancer
Gastrointestinal function
Operation stress
Quality of life
Prognosis
