微创医学

目的比较腹腔镜与开腹手术治疗老年结直肠肿瘤患者的临床效果。方法回顾性分析294例老年结直肠肿瘤患者的临床资料，其中接受腹腔镜手术治疗者168例（腹腔镜组），接受开腹手术治疗者126例（开腹手术组）。比较两组患者的相关手术指标及生化指标。其中手术指标包括手术时间、术中出血量、淋巴结清扫数量、术后肠内营养建立时间、下床活动时间、住院时间；生化指标包括前白蛋白（PA）、超敏C反应蛋白（hs-CRP）、降钙素原（PCT）等。结果与开腹手术组相比，腹腔镜组手术时间较长，术中出血量较少，建立肠内营养与下床活动时间较早，住院时间较短（P＜0.05）。两组淋巴结清扫数量比较，差异无统计学意义（P＞0.05）。术前两组患者的PA、hs-CRP和PCT水平比较，差异均无统计学意义（P＞0.05）。术后第1天，两组PA水平均降低，组间比较差异无统计学意义（均P＞0.05）；hs-CRP和PCT水平均升高，开腹手术组高于腹腔镜组（均P＜0.05）。术后第3、5、7天，两组PA水平均升高，且腹腔镜组高于开腹手术组（均P＜0.05）；hs-CRP和PCT水平均下降，且腹腔镜组低于开腹手术组（均P＜0.05）。结论与开腹手术相比，腹腔镜手术治疗老年结直肠肿瘤患者具有对营养代谢的影响较小、炎性反应较轻、体能恢复较快等优势。

ObjectiveTo compare the clinical effects between laparoscope and open surgery in the treatment of elderly patients with colorectal tumors. MethodsThe clinical data of 294 elderly patients with colorectal tumors were analyzed retrospectively. Of them, 168 patients received laparoscopic surgery (laparoscope group), whereas 126 patients received open surgery(open surgery group). The operation and biochemical indexes of the two groups were compared. The operation indexes included operation duration, intraoperative blood loss, number of lymph node dissection, establishment time of postoperative enteral nutrition, out-of-bed activity time and hospital stays, and the biochemical indexes included prealbumin (PA), high sensitive C-reactive protein (hs-CRP), procalcitonin (PCT), etc. ResultsCompared to the open surgery group, the laparoscope group had longer operation duration, less intraoperative blood loss, earlier establishment time of postoperative enteral nutrition and out-of-bed activity time, as well as shorter hospital stays (P＜0.05). There was no statistically significant difference in the number of lymph node dissection between the two groups (P＞0.05). There was no significant difference in the levels of PA, hs-CRP, or PCT between the two groups before operation (P＞0.05). On the first day after operation, the level of PA decreased, there was no statistically significant difference between the two groups (all P＞0.05); the levels of hs-CRP and PCT increased (all P＜0.05), with the levels were significantly higher in the open surgery group than in the laparoscope group. On the 3rd, 5th and 7th day after operation, the level of PA increased, with the level was significantly higher in the laparoscope group than in the open surgery group (all P＜0.05); while the levels of hs-CRP and PCT decreased in both groups, with the levels were lower in the laparoscope group than in the open surgery group (all P＜0.05). ConclusionCompared to the open surgery, the laparoscopic surgery for elderly patients with colorectal cancer has the advantages of less impact on nutrient metabolism, lighter inflammatory response, and faster recovery of stamina.