腹腔镜和开腹结直肠手术的炎性反应比较

Comparison of inflammatory response after laparoscopic and conventional surgery for colorectal carcinoma

目的 对比分析腹腔镜和开腹结直肠手术患者全身和腹腔炎性反应的差异，为腹腔镜手术对结直肠肿瘤中的应用提供理论依据。方法对51例2004年4—8月间收治的乙状结肠和直肠恶性肿瘤患者，采用腹腔镜辅助手术25例（LAP组），开腹手术26例（OPEN组）。术毕骶前留置引流管。观察并比较两组患者的一般情况和炎性反应及与手术相关的各项指标。结果两组患者在年龄、性别、ASA分级、术前血红蛋白及白蛋白水平、肿瘤Dukes分期和手术方式差异均无统计学意义（P〉0．05）。在切口长度、手术时间、肠道功能恢复时间、住院时问的比较中，LAP组占有明显优势（P〈0．05）。腹腔引流量在术后第1天，两组间差异无统计学意义（P〉0．05）；而术后2-4d，LAP组明显低于OPEN组（P〈0．05）。LAP组术后第1天，周围血中性粒细胞[（7．30±2．62）×10^9／L]、白介素（IL）-10[（19．46±3．31）pg／ml]和C反应蛋白（CRP）[（2．76±2．17）mg／dl]水平均显著低于OPEN组（P〈0．05），术后第4天两组间差异无统计学意义（P〉0．05）。术后第1天，两组腹腔引流液的IL-10、肿瘤坏死因子（TNF）及CRP水平差异无统计学意义（P〉0．05），术后第4天LAP组IL-10[（22．53±15．47）pg／ml]明显低于OPEN组（P〈0．05）。结论术后早期，腹腔镜结直肠手术的腹腔炎性反应与开腹手术相当，而全身炎性反应较开腹手术轻。腹腔镜结直肠手术临床上体现出恢复快、并发症少、住院天数少的优势。

Objective To compare the systemic and local inflammatory response after laparoscopic and conventional surgery for colorectal carcinoma. Methods From April 2004 to Augest 2004, 51 colorectal cancer patients undergoing laparoscopic （ n = 25） and conventional open （ n = 26） colorectal resection were enrolled in the study. The general clinical data, and inflammatory response were compared between the two groups. Results There were no significant differences in age, sex, pre-operative levels of heamoglobin and albumin, Dukes stage and surgical procedure between the two groups（ P 〉 0. 05） . Laparoscopic surgery had more advantages over conventional open surgery such as incision, operating time, recovery time of bowel function, and hospitalization. On postoperative day（POD） 1, WBC count [ （7.30±2.62）×10^9/L], and the serum levels of IL-10[（19. 46±3.31） pg/ml] and C-reactive protein（CRP） [ （2.76±2. 17）mg/dl] were significantly lower in laparoscopic group than those in conventional group（ P 〈 0.05）, but there were no differences on POD 4 between the two groups（P 〉 0. 05） . There were no significant differences in the volume of peritoneal drainage fluid, and levels of IL-10, TNF and CRP in it on POD 1 between the two groups, but the volume of peritoneal drainage fluid decreased significantly from POD 2, and the level of IL-10 in it was significantly lower on POD 4 in laparoscopic group than that in conventional group. Conclusions In early stage after operation, intra-peritoneal inflammatory response caused by laparoscopic surgery is similar to that by conventional open surgery, but systemic inflammatory response is slighter than that by conventional open surgery for colorectal carcinoma.