腹腔镜根治术治疗直肠癌患者的疗效与机制研究

Effect and mechanism of laparoscopic radical resection of rectal carcinoma

摘要:

目的 探讨腹腔镜直肠癌根治术治疗直肠癌患者的疗效和患者胃肠功能的改善情况。方法 直 肠癌患者根据手术方法的不同分为腹腔镜组与开腹组，两组患者都严格遵循全直肠系膜切除原则，腹腔 镜组采用腹腔镜直肠癌根治术，开腹组采用开腹手术治疗，记录两组患者手术情况与胃肠功能改善效果。 结果 所有患者均完成手术，腹腔镜组无中转开腹情况。两组患者的手术方式、手术时间比较无差异（P >0.05）， 腹腔镜组的术中出血量少于开腹组（P <0.05）。腹腔镜组的术后肠鸣音恢复时间、排气时间及排便时间短于 开腹组（P <0.05）。腹腔镜组术前12 h 与术后72 h 胃动素、胃泌素比较无差异（P >0.05），术后72 h 胃动素、 胃泌素与开腹组比较有差异（P <0.05）。腹腔镜组术后14 d 的切口感染、吻合口漏、肺部感染、腹腔脓肿及 吻合口出血发生率低于开腹组（P <0.05）。结论 经过研究发现，在治疗直肠癌患者时，腹腔镜直肠癌根治术 具有很好的可行性与安全性，能减轻患者的创伤，促进胃肠动力恢复，有利于维持血清胃动素和胃泌素的平衡， 减少并发症的发生。

Abstract:

Objective To investigate the effect and mechanism of laparoscopic radical resection of rectal carcinoma and the influence on gastrointestinal function of the patients. Methods A total of 110 rectal carcinoma patients in our hospital were selected and divided into a laparoscopic group (76 patients) and a laparotomy group (34 patients) accorded to different surgical methods. The two groups of patients were strictly abide by the principle of total mesorectal excision (TME), the laparoscopic group was given laparoscopic radical resection of rectal carcinoma, the laparotomy group underwent laparotomy. The surgery effect and gastrointestinal function improvement in the two groups were recorded. Results All the patients completed the surgery and there was no conversion to open operation in the laparoscopic group. There was no significant difference in surgical method or operation time between the two groups (P > 0.05), and the amount of bleeding during operation in the laparoscopic group was significantly smaller than that in the laparotomy group (P < 0.05). The postoperative recovery time of bowel sound, exhaust time and defecation time in the laparoscopic group were significantly less than those in the laparotomy group (P < 0.05). In the laparoscopic group, there was no significant difference in the serum motilin or gastrin level at 12 h before operation and 72 h after operation (P > 0.05). There were statistical differences in the serum motilin and gastrin levels between the two groups at 72 h after operation (P < 0.05). On postoperative day 14, the total incidence of incision infection, anastomotic leakage, pulmonary infection, abdominal abscess and anastomotic bleeding in the laparoscopic group was significantly lower than that in the laparotomy group (P < 0.05). Conclusions Laparoscopic radical resection is feasible and safe in the treatment of rectal carcinoma. It can reduce trauma in the patients, promote the recovery of gastrointestinal motility, and is conducive to the maintenance of serum motilin and gastrin balance and reduction of the incidence of complications.