基于肠神经反应及营养状况分析侧方入路与中间入路腹腔镜手术治疗结直肠癌的效果

Analysis of the effect of laparoscopic surgery for colorectal cancer through lateral and intermediate approaches based on enteric nerve response and nutritional status

摘要:

目的 基于肠神经反应及营养状况分析侧方入路与中间入路腹腔镜手术治疗结直肠癌（CRC）的效果。方法 回顾性分析2021年2月－2024年3月该院收治的118例CRC患者的临床资料，根据手术入路不同，将患者分为A组（侧方入路，60例）和B组（中间入路，58例）。A组采用侧方入路施行腹腔镜CRC根治术，B组采用中间入路施行腹腔镜CRC根治术。术后均随访1个月。比较两组患者手术相关指标、术后胃肠功能恢复情况、术前和术后1个月的肠神经反应和营养状况、随访期间的手术并发症，以及血管损伤情况。结果 与A组比较，B组手术时间、镇痛时间、住院时间、肠鸣音恢复时间、进食时间和肛门排气时间明显缩短，术中出血量明显减少，淋巴结清扫数目明显增多，差异均有统计学意义（P < 0.05）。与术前比较，两组患者术后1个月血清血管活性肠肽（VIP）、表皮生长因子（EGF）和P物质（SP）水平明显降低，且B组明显低于A组，差异均有统计学意义（P < 0.05）。与术前比较，两组患者术后1个月血清血红蛋白（Hb）、前白蛋白（PAB）、白蛋白（Alb）、视黄醇结合蛋白（RBP）、转铁蛋白（TFN）水平和预后营养指数（PNI）明显降低，但B组明显高于A组，差异均有统计学意义（P < 0.05）。随访期间，B组手术并发症总发生率和血管损伤率分别为3.45%和0.00%，明显低于A组的20.00%和10.00%，差异均有统计学意义（P < 0.05）。结论 相比于侧方入路，中间入路施行腹腔镜手术可明显减少术中出血量，缩短手术时间、镇痛时间和住院时间，增加淋巴结清扫数目，还可有效地促进CRC患者术后胃肠功能恢复，改善患者肠神经反应和营养状况，减少血管损伤，具有较高的安全性。

Abstract:

Objective To analyze the effect of laparoscopic surgery for colorectal cancer (CRC) through lateral and intermediate approaches based on enteric nerve response and nutritional status.Methods The research subjects were selected from 118 CRC patients who received treatment from February 2021 to March 2024, and their clinical data were retrospectively analyzed. They were divided into the group A (60 cases) and the group B (58 cases), with grouping based on surgical approach. Laparoscopic radical resection of CRC by the lateral approach was performed in the group A, and in the middle group, laparoscopic radical resection of CRC was performed by the middle approach. Both groups were followed up for 1 month. Postoperative indexes, gastrointestinal function recovery, intestinal nerve response and nutritional status before and 1 month after operation, surgical complications and vascular injury during follow-up were compared between the two groups.Results Compared with the group A, the group B had significantly shorter surgical time, analgesia time, hospitalization time, bowel sounds recovery time, feeding time, and anal exhaust time. Intraoperative bleeding was significantly reduced, and the number of lymph node dissection scans was significantly increased, with statistically significant differences (P < 0.05). Compared with before surgery, the levels of serum vasoactive intestinal peptide (VIP), epidermal growth factor (EGF), and substance P (SP) in both groups of patients were significantly reduced 1 month after surgery, and the group B was significantly lower than the group A, with statistically significant differences (P < 0.05). Compared with before surgery, the levels of serum hemoglobin (Hb), prealbumin (PAB), albumin (Alb), retinol-binding protein (RBP), transferrin (TFN) levels, and prognostic nutritional index (PNI) of both groups of patients were significantly reduced 1 month after surgery, but the group B was significantly higher than the group A, and the differences were statistically significant (P < 0.05). During the follow-up period, the total incidence of surgical complications and vascular injury rate in the group B were 3.45% and 0.00%, respectively, which were lower than those in the group A (20.00% and 10.00%), and the differences were statistically significant (P < 0.05).Conclusion Compared with the lateral approach, laparoscopic surgery performed through the middle approach can significantly reduce intraoperative bleeding, shorten the duration of surgery, analgesia, and hospitalization, increase lymph node dissection, and effectively promote postoperative gastrointestinal function recovery in CRC patients, improve intestinal nerve response and nutritional status, reduce vascular damage, and have high safety.