腹腔镜下钉座反穿吻合法联合经自然腔道取标本对低位直肠癌患者疗效及生活质量的影响  

Effect of laparoscopic nail seat reverseanastomosis combined with specimen collection through natural cavity on the treatment effect and quality of life of patients with low rectal cancer

作　　者：李文熙 郑鑫[1] 孙宝信[1] 张海生[1] 朱志达 赵恩宏[1] LI Wenxi;ZHENG Xin;SUN Baoxin;ZHANG Haisheng;ZHU Zhida;ZHAO Enhong(Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院胃肠外科,河北承德067000

出　　处：《中国肿瘤外科杂志》2022年第6期595-599,共5页Chinese Journal of Surgical Oncology

基　　金：承德市科学技术研究与发展计划项目(202006A085)。

摘　　要：目的探究腹腔镜下钉座反穿吻合法联合经自然腔道取标本对低位直肠癌患者治疗效果及生活质量的影响。方法选取承德医学院附属医院2018年4月至2021年6月收治的低位直肠癌患者86例,随机分为研究组和对照组,各43例。两组患者于腹腔镜下行直肠癌根治术并经自然腔道取标本,对照组联合传统荷包式缝合固定,研究组联合钉座反穿吻合法固定。比较两组患者手术情况(术中出血量、手术时间、术后初次排气时间及住院时间);于术前及术后3周,采用酶联免疫吸附试验检测血清炎性因子[C-反应蛋白(CRP)、肿瘤坏死因子(TNF)-α]、免疫因子[免疫球蛋白G(IgG)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]水平;记录患者术后3个月术后并发症发生情况;于术前及术后3个月评估患者生活质量(GIQLI)评分。结果研究组术中出血量、手术时间及住院时间均低于对照组(P<0.05)。术后,两组血清CRP、TNF-α水平及对照组IgG水平均高于术前(P<0.05);研究组术后血清CRP、TNF-α水平均低于对照组,IgG水平高于对照组(P<0.05)。与术前相比,术后两组血清MDA水平升高,SOD水平降低(P<0.05);研究组术后血清MDA水平低于对照组,SOD水平高于对照组(P<0.05)。研究组术后并发症发生率低于对照组(13.95%vs.2.33%,P<0.05)。两组患者术后GIQLI评分均较术前升高,研究组高于对照组(P<0.05)。结论腹腔镜下钉座反穿吻合法联合经自然腔道取标本治疗低位直肠癌疗效及安全性均优于联合传统荷包式缝合固定。Objective To explore the effect of laparoscopic nail seat reverse anastomosis combined with specimen collection through natural cavity on the treatment effect and quality of life of patients with low rectal cancer.Methods Eighty-six patients with low rectal cancer admitted to the Affiliated Hospital of Chengde Medical College from April 2018 to June 2021 were randomly divided into the study group and the control group,with 43 patients each.Two groups of patients underwent laparoscopic radical resection of rectal cancer and took samples through the natural lumen.The control group was combined with traditional purse string suture fixation,and the study group was combined with nail base reverse suture fixation.The operation conditions of the two groups were compared(intraoperative bleeding volume,operation time,first postoperative exhaust time and hospitalization time);The serum inflammatory factors[C-reactive protein(CRP)and tumor necrosis factor(TNF)-αwere detected by enzyme-linked immunosorbent assay before and 3 weeks after operation],immune factor[immunoglobulin G(IgG)],oxidative stress index[malondialdehyde(MDA),superoxide dismutase(SOD)]levels;The postoperative complications were recorded 3 months after operation;The patients quality of life(GIQLI)scores were evaluated before and 3 months after operation.Results The bleeding volume,operation time and hospitalization time in the study group were lower than those in the control group(P<0.05).After operation,serum CRP and TNF-αin the 2 groups and the level of IgG in the control group were higher than that before operation(P<0.05).Serum CRP and TNF-αin the study group after operation were lower than that in the control group.The level of IgG was higher than that before operation,and the GIQLI score of the study group was higher than the of the control group(P<0.05).Compared with that before operation,the level of serum MDA increased and the level of SOD decreased in the two groups after operation(P<0.05).The serum MDA level in the study group was lower than th

关 键 词：直肠肿瘤 腹腔镜检查 自然腔道内镜手术 钉座反穿吻合法 低位直肠癌 

分 类 号：R735.37[医药卫生—肿瘤]