腹腔镜辅助手术治疗高龄梗阻性结肠癌病人的临床分析

目的探讨腹腔镜辅助下手术治疗高龄梗阻性结肠癌病人的临床效果以及相关机制。方法采用前瞻性研究方法,选择2012年2月至2015年8月诊治的高龄梗阻性结肠癌病人120例,根据随机抽签原则分为观察组与对照组各60例,观察组采用腹腔镜辅助下手术治疗,对照组采用开腹手术治疗,记录两组预后情况。结果所有病人均顺利完成手术,观察组无中转开腹情况,不过观察组的术中出血量、肠蠕动恢复时间及术后住院时间均明显少于对照组,差异有统计学意义(P0.05),两组手术时间对比差异无统计学意义(P0.05)。观察组术后1个月的肺部感染、吻合口瘘、切口感染、肠梗阻等并发症发生率为6.7%,对照组为23.3%,观察组明显少于对照组,差异有统计学意义(P0.05)。观察组与对照组术前CD133阳性表达率分别为85.0%和81.7%,术后1个月的阳性表达率分别为6.7%和20.0%,观察组术后1个月的CD133阳性表达率明显低于对照组,差异有统计学意义(P0.05)。两组术后1个月的血清白细胞介素(IL)-6和IL-10含量均明显少于术前,差异有统计学意义(P0.05),同时术后1个月观察组的血清IL-6和IL-10含量也均明显少于对照组,差异有统计学意义(P0.05)。结论腹腔镜辅助下手术治疗高龄梗阻性结肠癌能减轻炎症反应,抑制CD133分子的表达,具有更好的微创性,能减少术后并发症的发生,从而促进病人康复。

Clinical analysis on laparoscopic assisted surgery in the treatment of elderly patients with obstructive colorectal cancer

Objective To investigate the clinical effects and related mechanisms of laparoscopic assisted surgery in the treatment of elderly patients with obstructive colorectal cancer.Methods Using a prospective study method,from February 2012 to August 2015,120 elderly patients with obstructive colorectal cancer in our hospital were selected and equally divided into observation group and control group randomly.The observation group was subjected to laparoscopic assisted surgery,and the control group received open surgery.The outcome was recorded in the two groups.Results The surgical operations were successfully performed in all patients,and there were no conversions to open surgery in observation group.The intraoperative bleeding was less,and intestinal peristalsis recovery time and postoperative hospital stay were shorter in the observation group than in the control group (P ＜0.05).The operation time between the two groups showed no significant difference (P＞0.05).The postoperative 1-month incidence of pulmonary infection,anastomotic leakage,wound infection,and intestinal obstruction in the observation group was 6.7％,significantly lower than the control group (23.3％,P＜0.05).The preoperative CD133 positive expression rate in the observation group and the control group was 85.0％ and 81.7％ respectively,and the postoperative 1-month positive expression rate of CD133 was 6.7％ and 20.0％ respectively,(P＜0.05).The serum IL-6 and IL-10 levels after operation in the two groups were significantly lower than those before operation (P＜ 0.05),and those in the observation group were significantly reduced as compared with those in the control group (P＜0.05).Conclusions Laparoscopic assisted surgery in the treatment of elderly patients with obstructive colorectal cancer can reduce inflammatory response,inhibit the expression of the CD133 molecule and decrease the incidence of postoperative complications,so as to promote the rehabilitation of patients.