腹腔镜结直肠癌手术对应激细胞因子ET、IL-6及CRP的影响

Effect of laparoscopic resection applied to patients with colorectal cancer on ET,IL-6 and CRP

目的：探讨腹腔镜结直肠癌手术对机体应激反应的影响。方法：选择2006年6月～2007年3月结直肠癌患者35例，分为腹腔镜组15例，开腹组20例。比较两组围手术期内皮素（ET）、白细胞介素-6（IL-6）、C-反应蛋白质（CRP）及相关临床指标的变化。结果：两组患者的性别、年龄、身高、体重、术后病理分期及手术方式差异无统计学意义（P〉0．05），平均手术时间腹腔镜组长于开腹组（P〈0．05）；术中平均出血量开腹组多于腹腔镜组（P〈0．05）。腹腔镜组术后第1天ET显著下降（P〈0．05），术后第3天恢复至术前水平；开腹组手术前后ET无显著变化。两组术后未出现显著差异。两组患者术后IL-6和CRP均明显升高（P〈0．01），且开腹组明显高于腹腔镜组（P〈0．01），术后第5天腹腔镜组IL-6恢复至术前水平，但开腹组仍明显高于腹腔镜组（P〈0．05）。术后第5天两组CRP仍显著高于术前水平（P〈0．05；P〈0．01），且开腹组高于腹腔镜组（P〈0．05）。结论：腹腔镜结直肠癌手术对ET、IL-6和CRP的影响小，应激反应比开腹手术轻、强度低、持续时间短。

Objective：To investigate the effect of laporoscopic resection applied to patients with colorectal cancer on systemic stress responses. Methods ： Thirty-five patients suffering colorectal cancer from Jun. 2006 to Mar. 2007 were selected. Fifteen of them accepted laparoscopic colectomy （laparoscopic group） and twenty accepted laparocolectomy （ laparotomy group）. Blood （ET）, endotheciuainter interleukin-6 （ IL-6 ）, C-reactive protein （CRP） levels and general clinical data in peri-operation stage were compared between the two groups. Results：There was no statistical difference between the two groups in sex, age, height, weight, pathological stage of tumor and surgical procedure （ P 〉 0.05 ）. The time of laparoscopic operation was significantly longer than laparotomy （ P 〈 0.05 ）. The volume of blood loss during laparotomy was larger than laparoscopic operation（ P 〈 0.05 ）. The blood ET level of patients in laparoscopic group decreased significantly on the 1 st day after operation （P 〈 0.05 ）, and resumed to pre-operation level on the 3rd day after operation, which remained normal in laparotomy group, and there was no statistical difference between the two groups after operation. The blood IL-6 and CRP levels of patients in both groups increased significantly（P 〈 0.01 ）, and it was higher in laparotomy group than in laparoscopic group. The blood IL-6 level resumed to pre-operation on the 5th day after operation,it was still higher in laparotomy group than in laparoscopic group（ P 〈 0.05 ）. The blood CRP level of patients in both groups on the 5th day after operation was still higher than that before operation（ P 〈 0.05, P 〈 0.01 ）, and it was higher in laparotomy group than in laparoscopic group（ P 〈 0.05 ）. Conclusions ：Laparoscopic colectomy brought less effect to blood ET, IL-6 and CRP levels, and less effect to systemic stress response intensity and time than laparotomy.