腹腔镜和开腹手术方式治疗低位直肠癌的疗效对比及对血浆miR-21表达水平的影响

摘要

Objective To investigate the effect of two kinds of operation method in the treatment of low rectal cancer and the influence on plasma miR - 21 expression level. Methods 120 patients with low rectal cancer treated from February 2011 to February 2015 were divided into two groups,and 60 cases in each group. The difference of the short - term effect and the plasma miR - 21 expression level in the two groups were compared and analyzed. Results The operative time,amount of bleeding,abdominal wall incision length,postoperative anal exhaust time,liquid time,indwelling catheter time,the beginning activity time,postoperative hospitalization time after operation,the number of patients using analge-sic,intraoperative or postoperative blood transfusion number of patients in the laparoscopic group were significantly better than those of laparotomy group with significant differences (P < 0. 05). The rate of complication after laparoscopic group was 5. 0%,laparotomy group was 23. 33%, the difference between the two groups was statistical significance (P < 0. 05). The expression level of miR - 21 in the two groups were signifi-cantly decreased after treatment (P < 0. 05),and the result of the laparoscopic group was significantly better than that of the control group (P <0. 05). Patients in the laparoscopic group showed better efficacy in cancer mortality,recurrence rate and one - year survival rate than laparotomy. Conclusion Laparoscopic surgery for low rectal cancer is significantly better than open surgery,and the plasma miR - 21 expression level may be a sensitive indicator for predicting the effect of laparoscopic surgery.%目的 探讨腹腔镜和开腹手术方式治疗治疗低位直肠癌的疗效对比及对血浆miR-21表达水平的影响.方法 选择2011年2月至2015年2月收治的低位直肠癌患者120例,按照患者治疗意愿分为腹腔镜手术组和开腹手术组,每组60例.使用RT-PCR方法检测两组患者治疗前后血浆miR-21表达水平变化.对比分析两组患者术后近期效果和血浆miR-21表达水平的差异,并分析一年后的预后结果.结果 腹腔镜组患者手术时间、术中出血量、腹壁切口长度、术后肛门排气时间、进流食时间、留置尿管时间、术后下床活动时间、术后住院时间、术后使用镇痛剂人数、术中或术后输血人数等均明显优于开腹组患者,差异均有统计学意义(P<0.05);腹腔镜组患者手术后并发症发生率为5.0%,明显低于开腹组的23.33%,差异有统计学意义(P<0.05).两组患者治疗后血浆miR-21表达水平均明显下降(P<0.05),腹腔镜组下降结果明显优于对照组(P<0.05).1年后的预后结果表明,腹腔镜组在术后肿瘤致死率、复发率和一年生存率上显著优于开腹组(P<0.05).结论 腹腔镜手术治疗低位直肠癌效果明显优于开腹手术治疗,且患者血浆miR-21表达水平可能成为预测腹腔镜手术治疗效果的敏感性指标.