经自然腔道腹腔镜结直肠癌根治术对患者术后疼痛、炎症反应、肠道屏障功能影响及卫生经济学评价  

Effect of laparoscopic radical resection of colorectal cancer through natural cavity on postoperative pain,inflammatory response,and intestinal barrier function in patients and health and economics evaluation

作　　者：谢伟 汪想忠 赵柯[1] 崔苏阳[1] 李飞[1] XIE Wei;WANG Xiangzhong;ZHAO Ke;CUI Suyang;LI Fei(Department of General Surgery,Jurong People Hospital,Jiangsu Province,Jurong 212400,China)

机构地区：[1]江苏省句容市人民医院普外科,江苏句容212400

出　　处：《中国医药导报》2022年第20期96-99,共4页China Medical Herald

基　　金：江苏省社会科学基金项目(BE2018660);江苏省镇江市社会发展指导性项目(FZ2019016)。

摘　　要：目的评价经肛门自然腔道标本取出(ta-NOSE)对患者术后疼痛、炎症反应、肠道屏障功能及卫生经济学的影响。方法选取2018年6月至2021年3月江苏省句容市人民医院实施腹腔镜结直肠癌根治术(LCR)的患者60例,根据随机数字表法分为两组,各30例。LCR组采用常规LCR治疗,ta-NOSE组在LCR术后采用ta-NOSE治疗。比较两组手术相关指标及疼痛、炎症、肠道屏障功能指标及并发症发生情况、卫生经济学评价。结果ta-NOSE组术中出血量少于LCR组,术后排气时间及术后住院时间短于LCR组(P<0.05)。术后3 d,两组视觉模拟评分法(VAS)评分高于术后1 d(P<0.05)。术后1、3 d,ta-NOSE组VAS评分低于LCR组(P<0.05)。两组不同时间点血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)与血浆D-乳酸、二胺氧化酶(DAO)组内比较,差异有统计学意义(P<0.05)。术后1、3 d,两组血清CRP、TNF-α与血浆D-乳酸、DAO比较,差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。两组直接医疗成本比较,差异无统计学意义(P>0.05);ta-NOSE组直接非医疗成本、间接医疗成本及总成本低于LCR组(P<0.05)。结论结直肠癌患者采用ta-NOSE较常规LCR的创伤更小,术后恢复快,应激炎症反应轻,卫生经济学价值更高。Objective To evaluate the effects of trans-anal nature orifice specimen extraction(ta-NOSE)on postoperative pain,inflammatory response and intestinal barrier function in patients and health and economics.Methods Sixty patients underwent laparoscopic colorectal resection(LCR)in Jurong People Hospital,Jiangsu Province from June 2018 to March 2021 were selected,they were divided into two groups by random number table method,with 30 cases in each group.LCR group was treated with routine LCR,and ta-NOSE group was treated with ta-NOSE after LCR.The operation related indexes,pain,inflammation,intestinal barrier function indexes,complications,and health economic evaluation were compared between two groups.Results The amount of intraoperative bleeding in ta-NOSE group was less than that in LCR group,and the postoperative exhaust time and postoperative hospital stay in ta-NOSE group were shorter than those in LCR group(P<0.05).At three days after operation,visual analogue scale(VAS)scores of two groups were higher than those at one day after operation(P<0.05).At one day and three days after operation,VAS scores of ta-NOSE group was lower than those of LCR group(P<0.05).There were statistically significant differences in serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),plasma D-lactic acid,and diamine oxidase(DAO)between two groups at different time points(P<0.05).At one day and three days after operation,serum CRP and TNF-α,plasma D-lactic acid,and DAO between two groups were compared,and the differences were statistically significant(P<0.05).There was no significant difference in total incidence of complication between two groups(P>0.05).There was no significant difference in direct medical cost between two groups(P>0.05);and the direct non-medical cost,indirect medical cost,and total cost in ta-NOSE group were lower than those in LCR group(P<0.05).Conclusion Compared with conventional LCR,ta-NOSE in patients with colorectal cancer has less trauma,faster postoperative recovery,less stress and inflammation,a

关 键 词：结直肠癌根治术 腹腔镜 经肛门自然腔道标本取出 

分 类 号：R735.3[医药卫生—肿瘤]