| 摘要: |
| 目的:研究腹腔镜根治术治疗血管变异的远端乙状结肠和直肠癌的临床效果。方法:选取2016年12月—2018年12月在我院接受治疗的120例伴血管变异远端乙状结肠癌和直肠癌患者为研究对象，分为开腹组(58例)与腹腔镜组(62例)。开腹组行开腹结直肠癌根治术，腹腔镜组行腹腔镜下结直肠癌根治术，比较两组患者的手术时间、出血量、住院时间、胃肠激素水平和治疗效果及术后胃肠功能恢复情况。结果:两组手术时间差异无统计学意义(P>0.05)；腹腔镜组手术过程中患者的出血量[(136.58±62.26)mL]及住院时间[(12.78±1.73)d]均明显少于开腹组[(188.24±72.21)mL和(20.67±1.52)d，P<0.05]。且开腹组术后排气时间[(1.27±0.43)d]、排便时间[(3.45±0.86)d]及肠鸣音恢复时间[(0.63±0.58)d]均多于腹腔镜组[(3.24±1.24)d、(5.25±1.43)d、(1.85±0.69)d)，P<0.05]；两组术前24 h胃动素和胃泌素差异无统计学意义(P>0.05)；术后96 h，两组患者胃动素和胃泌素均不同程度降低，且开腹组下降更明显，差异有统计学意义(P<0.05)。腹腔镜组术后切口感染、吻合口出血、肺部感染、腹腔脓肿及恶心呕吐的总发生率(5%)低于开腹组(14%)，差异有统计学意义(P<0.05)。结论:腹腔镜结直肠癌根治术对伴血管变异远端乙状结肠癌和直肠癌患者具有良好的效果和安全性，可减轻患者腹部的创伤，降低并发症的发生率，有助于维持患者血清中胃动素和胃泌素的相对平衡，促进患者术后胃肠功能恢复，临床疗效好。 |
| 关键词: 血管变异 乙状结肠癌 直肠癌 腹腔镜根治术 |
| DOI：10.3969/j.issn.1007-6948.2021.04.010 |
| 投稿时间：2020-06-25 |
| 基金项目:上海市崇明区“可持续发展科技创新行动计划”项目(CKY2018-1) |
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| Laparoscopic Radical Resection for the Treatment of Vascular Variant Distal Sigmoid Colon and Rectal Cancer |
| Gong Qing-hao,Zhang Jie,Chen Hai-qun |
| Department of General Surgery, Chongming Branch of Shanghai Xinhua Hospital, Shanghai 202150, China |
| Abstract: |
| Objective To explore the treatment of vascular variants of distal sigmoid colon and rectal cancer with laparoscopic radical resection and to provide clinical guidance. Methods A retrospective selection of 120 patients with distal sigmoid colon cancer and rectal cancer with vascular variants were selected as the research objects. According to the different surgical methods, the above-mentioned patients were divided into laparotomy group (58 cases) and laparoscopic group (62 cases). Laparotomy group underwent laparotomy for radical resection of colorectal cancer, and laparoscopic group underwent laparoscopic radical resection of colorectal cancer. The operation time, blood loss, length of hospitalization, gastrointestinal hormone levels, treatment effects and postoperative stomach in the two groups as well as recovery of bowel function were all analyzed. Results There was no statistically significant difference in the operation time between the two groups of patients (P>0.05), but the bleeding volume [(136.58±62.26) mL] and hospitalization time [(12.78±1.73) d] of the patients in the laparoscopic group during the operation were significantly less than those of the open group [(188.24±72.21) mL/(20.67±1.52) d] (P<0.05). In addition, the postoperative exhaust time [(1.27±0 . 43 ) d], defecation time [( 3 . 45 ±0 . 86 ) d] and bowel sound recovery time [(0.63±0.58) d] in the open-abdominal group were more than those in the laparoscopic group [(3.24±1.24) d, [(5.25±1.43) d, (1.85±0.69) d] (P<0.05). There was no significant difference between motilin and gastrin in the open group and the laparoscopic group 24h before the operation (P>0.05). The gastric motility of the two groups was 96h after the operation. Both gastrin and gastrin decreased to varying degrees, but the decrease was more signi?cant in the laparotomy group (P<0.05). At the same time, the total incidence of incision infection, anastomotic bleeding, lung infection, abdominal abscess, nausea and vomiting in the laparoscopic group (5.00%) were lower than those in the open group (13.79%) (P<0.05). Conclusion Laparoscopic radical resection of colorectal cancer has good feasibility and safety for patients with distal sigmoid colon cancer and rectal cancer with vascular variation. It can reduce the trauma of the patient' s abdomen, reduce the incidence of complications and help maintain the patient' s serum. The relative balance of motilin and gastrin promotes the recovery of gastrointestinal function after surgery which the clinical effect is good. |
| Key words: vascular variation sigmoid colon cancer rectal cancer laparoscopic radical surgery |
