不同入路腹腔镜根治术治疗右半结肠癌的临床效果及血清指标观察

目的研究不同入路腹腔镜根治术(LRR)治疗右半结肠癌(RCC)的效果及对血清钙结合蛋白S100A9(S100A9)、人衰老关键蛋白1(FBLN1)、糖类抗原199(CA199)及机体应激的影响。方法选择2014年7月至2017年6月我院收治的RCC患者114例,依照随机数字表法分为A组与B组各57例,A组行中间入路LRR,B组行尾侧入路LRR。观察两组患者出血量、手术时间、清扫淋巴结数目、术后排气时间、流质饮食恢复时间及术后住院时间等围术期指标;术前及术后7 d血清S100A9、FBLN1、CA199等肿瘤相关因子水平;术前及术后1 d血清皮质醇(Cor)、醛固酮(ALD)、促肾上腺皮质激素(ACTH)等应激因子水平,以及术后并发症。结果A组出血量、手术时间均大于B组(P<0.05);两组清扫淋巴结数目、术后排气时间、流质饮食恢复时间及术后住院时间差异均无统计学意义(P>0.05);术后7 d,两组血清S100A9、FBLN1、CA199水平差异均无统计学意义(P>0.05)。术后1 d A组血清Cor、ALD、ACTH水平均高于B组(P<0.05)。A组术后并发症发生率高于B组(P<0.05)。结论中间入路LRR、尾侧入路LRR治疗RCC均可有效切除病灶,降低血清S100A9、FBLN1、CA199水平。与中间入路LRR相比较,尾侧入路LRR治疗RCC具有创伤小、操作简单、对机体应激小、应激因子产生少、术后并发症发生率低等优势。

The clinical efficacy and levels of serum tumor markers in different operation approaches of laparoscopic radical resection of right colon carcinoma

Objective To investigate the effect of different operation approaches of laparoscopic radical resection(LRR)in the treatment of right colon cancer(RCC)and its effect on serum S100A9,FBLN1 and CA199 as well as stress.Methods One hundred and forty-four RCC patients who were admitted to our hospital from July 2014 to June 2017 were involved in this study.The patients were divided into group A and B using the random number table method,70 in each group.The group A was given LRR of intermediate approach while the group B was given LRR of caudal approach.Blood loss,operative time,number of lymph nodes dissected,postoperative exhaust time,recovery time of fluid diet and postoperative hospital stay were observed.Serum tumor related factors such as S100A9,FBLN1 and CA199 were observed before and after 7 days of treatment.Stress factors such as serum cortisol(Cor),aldosterone(ALD),adrenocorticotropic hormone(ACTH)as well as postoperative complications were also observed before and after 1 day of treatment.Results The blood loss and operative time in the group A were more or longer than those in the group B(P<0.05).There was no difference in the number of lymph nodes dissected,postoperative exhaust time,recovery time of fluid diet and postoperative hospital between the two groups(P>0.05).After 7 days of treatment,there was no difference in the levels of serum S100A9,FBLN1 and CA199 between the two groups(P>0.05).After 1 day of treatment,the levels of Cor,ALD and ACTH in the group A were higher than those in the group B(P<0.05).The incidence of postoperative complications in the group A were higher than that in the group B(P<0.05).Conclusion Both intermediate and caudal approach can effectively remove lesions of RCC and reduce the serum levels of S100A9,FBLN1 and CA199.Compared with LRR of intermediate approach,LRR of caudal approach has advantages such as fewer traumas,simple operation,less stress on the body and less production of stress factors,and the incidence of postoperative complications is low.