比较腹腔镜手术与常规开腹手术对右半结肠癌切除术后创伤应激的影响

摘要

目的 观察腹腔镜手术与常规开腹手术对右半结肠切除术后患者创伤应激的影响.方法 纳入70例右半结肠癌患者作为研究对象,随机分为两组,每组各35例.观察组行腹腔镜手术,对照组行常规开腹手术.比较两组手术基本情况、围术期炎性因子及创伤应激相关指标变化情况.结果 观察组术中出血量、切口长度、术后肛门首次排气时间及住院时间均显著优于对照组(均P＜ 0.05),两组淋巴结清扫数目无显著性差异(P＞0.05),观察组手术时间显著长于对照组(P＜0.05).两组术后1 d(T2)、术后3 d(T3)及术后1 w(T4)时TNF-α、IL-6及CRP水平均显著高于术前1 d(T1)(均P＜0.05),观察组T2、T3及T4时TNF-α、IL-6及CRP均显著低于对照组(均P＜0.05).观察组T2、T3及T4时皮质醇、醛固酮、血糖及肾上腺素水平显著低于对照组(均P＜0.05).结论 腹腔镜右半结肠癌手术较常规开腹右半结肠癌手术能降低患者的创伤应激反应,更有利于术后早期康复.%Objective To compare the effect of laparoscopic surgery and conventional open surgery on traumatic stress response after resection of right-sided colon cancer.Methods 70 patients with right colon cancer were enrolled and randomly assigned to two groups,with 35 cases in each group.The treatment group underwent laparoscopic surgery,and the control group routine laparotomy.Indices related to operation,perioperative inflammatory factors and traumatic stress indexes were compared between the two groups.Results The amount of bleeding,incision length,time to anal exhaust and the length of stay in the treatment group were better than those in the control group (P ＜ 0.05).There was no significant difference between the two groups in the number of lymph node dissected (P ＞0.05).The operation duration in the treatment group was significantly higher than that in the control group (P ＜ 0.05).The TNF-α,IL-6 and CRP levels in both groups 1 day (T2),3 days (T3),1 week after operation (T4) were significantly higher than those 1 day before operation (T1) (P ＜ 0.05).The TNF-α,IL-6 and CRP in the treatment group at T2,T3 and T4were significantly lower than those in the control group (P ＜ 0.05).The cortisol,aldosterone,blood glucose and epinephrine levels in the treatment group at T2,T3 and T4 were significantly lower than those in the control group (P ＜ 0.05).Conclusion The laparoscopic surgery for right-sided colon cancer is more effective than routine open surgery to improve postoperative traumatic stress response.It can promote early postoperative rehabilitation.