改良保护性肠造口术应用于老年梗阻性乙状结肠癌患者的效果观察  

Effect of modified protective enterostomy for obstructive sigmoid colon cancer in elder patients

作　　者：于勇 黄克华 吕顺 YU Yong;HUANG Kehua;LYU Shun(Department of General Surgery,Liaoyang Central Hospital of Liaoning Province,Liaoyang,Liaoning,111000)

机构地区：[1]辽宁省辽阳市中心医院普外科,辽宁辽阳111000

出　　处：《实用临床医药杂志》2021年第20期68-72,共5页Journal of Clinical Medicine in Practice

摘　　要：目的观察改良保护性肠造口术对老年梗阻性乙状结肠癌患者的疗效及患者围术期炎性因子变化情况。方法选取梗阻性乙状结肠癌手术治疗患者96例作为研究对象,采用随机盲法分为观察组50例和对照组46例。观察组采用改良保护性肠造口术治疗,对照组采用回肠袢式造口术治疗。比较2组患者的疗效、炎性因子水平、血清胃泌素(GAS)水平、肝细胞生长因子(HGF)水平、并发症发生情况和预后情况。结果Ⅰ期、Ⅱ期手术后,观察组术后禁食时间、住院时间和排气时间均短于对照组,差异有统计学意义(P<0.05);观察组Ⅱ期手术后并发症总发生率低于对照组,差异有统计学意义(P<0.05)。术后,观察组血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、GAS、HGF水平均低于对照组,健康状况调查简表(SF-36)各维度评分均高于对照组,差异有统计学意义(P<0.05);观察组患者术后24个月的累积复发率、累积病死率均低于对照组,差异有统计学意义(P<0.05)。结论改良保护性肠造口术应用于老年梗阻性乙状结肠癌患者中疗效显著,可有效降低炎性因子水平,促进患者术后恢复,改善患者生活质量及远期预后。Objective To observe the effect of modified protective enterostomy for elderly patients with obstructive sigmoid carcinoma,and analyze the changes of inflammatory factors during perioperation.Methods A total of 96 patients with obstructive sigmoid colon cancer undergoing surgery were selected,and were divided into observation group(n=50)and control group(n=46)according to randomized blinded method.The observation group was treated with improved protective enterostomy,and the control group was treated with loop ileostomy.The therapeutic efficacy,inflammatory factors,serum gastrin(GAS),hepatocyte growth factor(HGF),occurrence of complications and prognosis were compared.Results After surgery of phase I andⅡ,the postoperative fasting time,hospitalization and exhaust time in the observation group were shorter than the control group(P<0.05);the total incidence of postoperative complications was lower than that of the control group(P<0.05).After surgery,the serum levels of interleukin-1(IL-1),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),GAS and HGF in the observation group were lower than those in the control group,and the scores of all dimensions in the 36-item Shot-form Health Status Survey(SF-36)were higher than those in the control group(P<0.05).The cumulative recurrence rate and cumulative mortality in the observation group 24 months after operation were lower than those in control group(P<0.05).Conclusion Modified protective enterostomy has a significant effect for elderly patients with obstructive sigmoid carcinoma,which can effectively reduce inflammatory factors,promote postoperative recovery,and improve the quality of life and long-term prognosis of patients.

关 键 词：梗阻性乙状结肠癌 改良保护性肠造口术 炎性因子 生活质量 预后 

分 类 号：R735.35[医药卫生—肿瘤] R730.56[医药卫生—临床医学]