1-13_腹腔镜与开腹手术治疗在结直肠癌治疗中的临床分析.doc

腹腔镜与开腹手术治疗在结直肠癌治疗中的临床分析 李贵全1 吴本华 黄家斌 任显坤 摘要 目的 观察并分析腹腔镜和开腹手术治疗结肠癌的疗效及安全性，进一步探析腹腔镜手术治疗结直肠癌的可行性、有效性以及安全性，为今后手术方式的选择提供新思路。方法 回顾性分析本院胃肠外科2012年2月~2014年2月期间156例行手术治疗的结直肠癌住院患者的临床资料，根据手术方式将其分为2组，每组78例，对照组行常规开腹手术，研究组行腹腔镜手术，对比分析两组患者手术效果及并发症等情况。结果 研究组手术时间长于对照组，而切口长度、术中出血量、淋巴结清扫数、术后镇痛次数、肛门排气时间、住院时间均明显短于对照组，组间比较差异有显著统计学意义（P＜0.05），术后并发症发生率为5.13%明显低于对照组的21.79%（χ2=9.2995,P=0.0023）；两组患者术后第1d、6dCRP、SAA水平较术前均明显升高，术后第1d IL-6水平均明显升高，对照组升高程度较研究组更为明显（P＜0.05），术后第6d研究组IL-6降低至术前水平而开腹术者明显高于术前水平（P＜0.05）；术后第1d两组患者CD3+、CD4+、CD4+/CD8+水平较手术前均明显下降（P＜0.05），对照组下降程度较治疗更明显（P＜0.05），术后第6d，研究组基本恢复至术前水平而对照组尚未恢复且明显低于研究组上述指标水平（P＜0.05）。结论 腹腔镜根治性切除术治疗结直肠癌疗效确切，术后并发症少，安全性高，机体产生应激反应和细胞免疫功能抑制程度明显弱于开腹结直肠癌根治术，促进患者术后早期恢复。 关键词 结直肠癌；腹腔镜；开腹；疗效；安全性 Clinical analysis in the treatment of colorectal cancer treated by laparoscopic operation and laparotomy Abstract Objective Efficacy and safety of laparoscopic and open operation for the treatment of colon cancer were observed, further analysis of laparoscopic operation for the treatment of colorectal cancer the feasibility, effectiveness and safety, to provide new ideas for the future operation mode selection. Methods A retrospective analysis of our hospital in 2012 February ~2014 year in February the Department of gastrointestinal surgery for colorectal cancer in 156 cases during operation of hospitalization in patients with clinical data, according to the operation mode can be divided into 2 groups, 78 cases in each group, the control group underwent conventional open operation, laparoscopic operation research group, compared two groups of patients with operation effect and complications. Results Study group for operation longer than control group and incision length, amount of bleeding, number of lymph nodes, number of postoperative pain, flatus, hospital stays were significantly shorter than in the control group, there was a significant difference between the groups was statistically significant (P0.05), postoperative complication rate of 5.13% was significantly lo