开腹与腹腔镜直肠癌切除术对腹膜溶解能力的影响

Effects of laparotomy and laparoscopic resection on peritoneal lysis in rectal cancer

目的比较开腹与腹腔镜直肠癌切除术对腹膜溶解能力的影响。方法选取2014年5月至2016年8月本院收治的78例直肠癌手术患者为研究对象,随机分为腹腔镜组与开腹组,每组各39例。两组均于手术开始时、术毕切取大网膜标本并采用ELISA法检测腹膜组织的组织型纤溶酶原激活物(t-PA)、组织型纤溶酶原激活物抑制物(PAI-1)、基质金属蛋白酶-3(MMP-3)及基质金属蛋白酶抑制因子(TIMP-1)水平,比较两组手术时间、术中出血量、切除长度、清除淋巴结个数。结果腹腔境组术毕时t-PA、MMP-3分别为(1384.11±107.29)pg/mL、(986.29±15.44)pg/mL,均低于本组手术开始时、高于开腹组术毕时(P<0.05);腹腔境组术毕时的PAI-1、TIMP-1分别为(2210.77±160.33)pg/mL、(2762.10±178.22)pg/mL,均高于本组手术开始时、低于开腹组术毕时(P<0.05)。腹腔镜组手术时间长于开腹组,术中出血量少于开腹组(均P<0.05),两组切除长度与清除淋巴结个数的差异无统计学意义(均P>0.05)。结论腹腔镜手术可达到与开腹手术相当的清扫效果,且出血少,腹膜损伤轻,更利于保持腹膜溶解功能。

Objective To compare the effect of laparoscopic resection of laparotomy on peritoneal lysis. Methods 78 patients with rectal cancer were selected and divided into laparoscopic group and laparotomy group according to the random number table, with 39 cases in each group.. The levels of t-PA,PAI-1, MMP-3 and.TIMP-1 in peritoneal tissues were measured by ELISA. The operation time,intraoperative blood loss,resection length, and the number of lymph nodes cleared were compared between the two groups. Re- suits The levels of t-PA and MMP-3 were （1384.11±107.29） pg/mL,and （986.29±15.44） pg/mL respectively in laparoscopic group after the surgery,which were lower than those at baseline of this group,and higher than in laparotomy group after the surgery （P 〈 0.05）. The levels of PAI-1 and TIMP-1 in laparoscopic group after the surgery were （2210.77±160.33） pg/mL,and（2762.10±178.22） pg/mL,respectively,which were higher than those at the baseline of this group, and lower than in laparotomy group after the surgery （P 〈 0.05）. The operation time of laparoscopic group Was longer than that of laparotomy group, and the intraoperative blood loss was less than that of laparotomy group （all P 〈 0.05）. There was no significant difference in resection length and the number of lymph nodes cleared between the two groups. Conclusion Laparoscopic surgery could achieve similar effect as laparotomy,with less bleeding,less peritoneal injury, and was useful to maintain the dissolution function of peritoneal.