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目的探讨高龄高危低位直肠癌患者的手术方式及临床效果。方法收集2006年8月至2010年8月间收治的高龄(>80岁)低位直肠癌患者(肿瘤距肛门3～5cm)120例,根据手术方式不同分为3组:A组(Dixons术+横结肠造瘘组)、B组(Hartmann术组)和C组(Miles术组)。检测手术前后血清C反应蛋白(CRP)及白介素6(IL-6)水平,分析比较患者术中及术后出血、术后肠道功能恢复情况、盆腔积液感染和住院周期。结果术后24h和48h患者血清IL-6水平监测结果,各治疗组均明显高于手术前(P<0.05)。术后24h,A组与B组差异无统计学意义(P>0.05),A组与C组间差异有统计学意义(P<0.05)。术后48 h,各组血清IL-6水平均低于术后24 h,A组与B组无明显差异,C组高于其他两组,差异有统计学意义(P<0.05)。术后24h和48h血清CRP水平均明显高于术前(P<0.05),其中C组升高的幅度最大,B组次之,A组最小,A组与B组无明显差异,但C组高于其他两组(P<0.05)。A组术中术后出血、盆腔积液明显少于B组和C组。A组肠道排气早于B组和C组。A组住院周期短于B和C组。结论超低位吻合并横结肠预防造瘘术较其他术式并发症少,康复快,可作为高龄高危低位直肠癌患者的首选手术方式。
Objective To investigate the surgical methods and clinical effects of high-risk patients with rectal cancer at lower risk. Methods One hundred and twenty cases of elderly patients (> 80 years old) with low rectal cancer (tumor size 3 ~ 5cm from the anus) admitted from August 2006 to August 2010 were divided into 3 groups according to different surgical methods: group A (Dixons + Transverse colostomy group), group B (Hartmann group) and group C (Miles group). Serum C-reactive protein (CRP) and interleukin 6 (IL-6) levels were measured before and after surgery. The intraoperative and postoperative bleeding, postoperative recovery of intestinal function, pelvic fluid infection and hospitalization were analyzed. Results The levels of serum IL-6 in 24h and 48h after operation were significantly higher in all treatment groups than those before operation (P <0.05). At 24 hours after operation, there was no significant difference between group A and group B (P> 0.05). There was a significant difference between group A and group C (P <0.05). At 48 h after operation, the levels of serum IL-6 in each group were significantly lower than those in the other two groups at 24 h postoperatively. There was no significant difference between group A and group B, and group C was significantly higher than the other two groups (P <0.05). The levels of serum CRP at 24h and 48h after operation were significantly higher than those before operation (P <0.05), and the increase in group C was the highest, followed by that in group B, the lowest in group A, and no significant difference between group A and group B Higher than the other two groups (P <0.05). A group of postoperative bleeding, pelvic fluid was significantly less than the B group and C group. Gastroduodenal evacuation in group A was earlier than that in group B and group C. Group A hospitalization cycle shorter than the B and C groups. Conclusion The results of ultra-low anastomosis and transverse colon precluding ostomy are less complicated than those of other surgical procedures, and recover quickly. It can be used as the first choice of surgical treatment for elderly patients at high risk and low rectal cancer.