腹腔镜下全系膜切除术治疗结直肠癌的临床研究  

Clinical study on laparoscopic total mesorectal excision for the treatment of colorectal cancer

作　　者：潘光明 曹权 杨海峰 王帮成 唐代清 Pan Guangming;Cao Quan;Yang Haifeng;Wang Bangcheng;Tang Daiqing(Department of Tumor and Hepatobiliary Surgery,Second Affiliated Hospital of Guizhou Medical University,Kaili 556000,Guizhou Province,China)

机构地区：[1]贵州医科大学第二附属医院肿瘤肝胆外科,凯里556000

出　　处：《中国基层医药》2025年第3期331-335,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨腹腔镜下全系膜切除术治疗结直肠癌的临床效果和优势。方法选择2020年1月到2023年1月贵州医科大学第二附属医院接受治疗的结直肠癌患者82例开展前瞻性研究,通过随机数字表法进行分组,每组各41例,对照组开展常规开腹手术治疗,观察组给予腹腔镜下全系膜切除术治疗,比较两组疗效、临床指标及免疫功能指标。结果观察组患者的手术时间[(1.98±0.31)h]、住院时间[(8.32±2.38)d]、肠道功能恢复时间[(2.15±0.34)d]和术中出血量[(112.35±12.66)mL]均短于、少于对照组的(2.46±0.32)h、(14.52±2.42)d、(3.25±0.15)d、(167.78±12.35)mL(t=6.90、11.70、18.95、20.07,均P<0.001);观察组的短期治疗有效率高于对照组(χ^(2)=4.10,P<0.05);观察组免疫功能指标CD_(4)^(+)/CD_(8)^(+)比值[(1.78±0.54)]、免疫球蛋白A(Immunoglobulin A,IgA)[(3.87±0.73)g/L]和免疫球蛋白G(Immunoglobulin G,IgG)[(11.83±2.88)g/L]均优于对照组的(1.36±0.53)、(1.78±0.63)g/L、(6.37±2.45)g/L(t=3.55、13.88、9.25,均P<0.001);观察组患者的并发症发生率[2.44%(1/41)]低于对照组[19.51%(8/41)](χ^(2)=4.49,P<0.05)。结论结直肠癌患者开展腹腔镜下全系膜切除术治疗具有恢复快、出血和并发症少等明显优势,相对于传统开腹手术效果更优。Objective To investigate the clinical effects and advantages of laparoscopic total mesorectal excision in the treatment of colorectal cancer.Methods A total of 82 patients with colorectal cancer who received treatment at the Second Affiliated Hospital of Guizhou Medical University from January 2020 to January 2023 were selected for a prospective study.They were randomly assigned to two groups using a random number table,with 41 cases in each group.The control group underwent conventional laparotomy,while the observation group received laparoscopic total mesorectal excision.Clinical efficacy,clinical indicators,and immune function indicators were compared between the two groups.Results The operation time for patients in the observation group was(1.98±0.31)hours,the length of hospital stay was(8.32±2.38)days,the recovery time for bowel function was(2.15±0.34)days,and the intraoperative blood loss was(112.35±12.66)mL,all of which were shorter and lower than those in the control group[(2.46±0.32)hours,(14.52±2.42)days,(3.25±0.15)days,and(167.78±12.35)mL,t=6.90,11.70,18.95,20.07,all P<0.001].The short-term response rate in the observation group was higher than that in the control group(χ^(2)=4.10,P<0.05).The immune function indicators in the observation group,including the CD_(4)^(+)/CD_(8)^(+)ratio(1.78±0.54),immunoglobulin A[(3.87±0.73)g/L],and immunoglobulin G[(11.83±2.88)g/L],were all better than those in the control group[(1.36±0.53),(1.78±0.63)g/L,(6.37±2.45)g/L,t=3.55,13.88,9.25,all P<0.001].The incidence of complications in the observation group was 2.44%(1/41),which was significantly lower than that in the control group[19.51%(8/41),χ^(2)=4.49,P<0.05].Conclusions Laparoscopic total mesorectal excision for patients with colorectal cancer has significant advantages,including faster recovery,less bleeding,and fewer complications,making it more superior to conventional laparotomy.

关 键 词：结直肠肿瘤 腹腔镜 肠系膜 免疫 手术后并发症 

分 类 号：R73[医药卫生—肿瘤]