腹腔镜结直肠癌手术对机体影响的探讨

Evaluation of the minimal invasiveness of laparoscopic operation for colorectal carcinoma

目的探讨腹腔镜下结直肠癌手术的低侵袭性。方法将符合纳入研究对象标准的40例结直肠癌患者随机分成腹腔镜组(20例)和开腹组(20例),比较两组患者围手术期(术前、术后当天、术后第1、3、5d)的外周血白介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)、可溶性细胞间黏附分子(sICAM-1)、白细胞CD11b的变化。结果开腹组术后细胞因子(TNF-α、IL-6、IL-8)明显高于腹腔镜组(P<0.05)。开腹组术后6h、第1天时,sICAM-1的动态变化较腹腔镜组显著升高,开腹组外周血白细胞CD11b在术后6h降至最低(161.98±48.42),较腹腔镜组(189.51±46.45)明显低(P<0.05)。结论结直肠癌的腹腔镜手术比传统开腹手术对机体影响小,具有明显的低侵袭性。

Objective To investigate the minimal invaslveness of laparoseopic operation for colorectal carcinoma. Methods Forty cases with pathologically proven colorectal carcinoma were divided into laparoseopic group （ n = 20） and open surgical group （ n ： 20）. Perioperative alterations of peripheral blood IL-6, IL-8, TNF- α, CRP, sICAM-1 and WBC CD11b were compared between the two groups. TNF-α, IL-6, IL-8 and sICAM-1 were determined by ELISA, CRP by scattered radiation turbidity comparison and WBC CD1 lb by flow cytometry with monoclonal antibody PS-CD11b, M2Ab. Results The postoperative cytokine levels of TNF-α, IL-6 and IL-8 in open surgery group were significantly higher than those in laparoseopic group （ P 〈 0.05）. Dynamic level of sICAM-1 at 6 and 24 hours after operation in open surgery group were significantly higher than those in laparoseopic group. Peripheral WBC CD11b decreased to the lowest level at 6 hours after operation in open surgery group, significantly lower than that in laparoscopic group （ P 〈 0.05） . Conclusion Laparoseopic surgery for colorectal carcinoma exerts less effects on patients than traditional open surgery, and can maintain patients＇ defense function, therefore it is less invasive.