腹腔镜和开腹结直肠癌根治术对胃肠运动功能的影响

Effect of radical resection of colorectal carcinoma via laparoscopy or laparotomy on gut movement:report of 42 cases

目的探讨经腹腔镜和开腹结直肠癌根治性切除对胃肠运动功能的影响。方法 2008年6月至2009年6月我科42例行结直肠癌根治术患者分为经腹腔镜和开腹2组,每组21例。记录2组手术后肠鸣音恢复时间和术后排气、留置胃管、开始进食、排便时间,并用高效液相法(HPLC)测定术前12h,术后24、48h对乙酰氨基酚(paracetamol,PAC)浓度。结果腹腔镜组术后肠鸣音恢复、排气、留置胃管、进食、排便时间与开腹组相比显著缩短(P<0.01);PAC峰浓度的时间出现在给药2h左右,2组术后24、48h液体胃排空功能较术前均显著下降(P<0.01),术后24h,腔镜组给药2hPAC浓度[(57.51±7.91)mg/L]与开腹组[(28.32±6.37)mg/L]比较差异有统计学意义(P<0.01),术后48h,2组相比无明显变化(P>0.05)。结论腹腔镜结直肠癌根治性切除术在术后肠鸣音恢复、肛门排气、排便、进食时间等方面恢复更快,明显优于传统开腹术。采用PAC药物吸收法测定液体胃排空的方法安全易行,可在床旁进行,且重复性好,适用于临床术后患者。

Objective To investigate the effect of laparoscopic or laparotomy radical resection of colorectal carcinoma on gut movement in patients.Methods Forty-two patients with colorectal carcinoma hospitalized in our department from June 2008 to June 2009 were equally divided into laparoscope group and laparotomy group.Their postoperative bowel tones recovery time,bowel releasing time,detaining time of gastric tube,food-taking time and defecation time were recorded.Concentration of paracetamol（PAC）12 h prior to and 12,24 and 48 h after surgery was measured with high performance liquid chromatography（HPLC）.Results Laparoscope group had shorter time in above-mentioned time periods than laparotomy group（P〈0.01）,and the peak concentration of PAC appeared in 2 h.Postoperative gut transmission function was significantly degressive in the 2 groups compared with it before operation（P〈0.01）,especially in laparotomy group.In 24 h after operation,the PAC concentration was 57.51±7.91 mg/L in laparoscope group and 28.32±6.37 mg/L in laparotomy group,with significant difference between them（P〈0.01）,but there was no difference in 48 h after operation.Conclusion The recovery period of gut movement is shorter in patients with radical resection of colorectal carcinoma by laparoscope,than by traditional laparotomy.Moreover,observing gut movement with PAC drug absorption is easy,safe and repeatable in clinical postoperative people.