高脂血症对直肠癌开腹及腹腔镜手术合并症的影响

Effects of hyperlipidemia on postoperative complications in patients of rectal cancer, open vs laparoscopic surgery

目的 探讨高脂血症状态对直肠癌手术合并症的影响.方法 回顾分析2005年3月至2009年9月接受开腹或腹腔镜直肠癌根治术的382例患者的临床资料,根据患者术前的血脂水平,分为高脂血症组及正常血脂组,采用卡方检验和t检验处理相关临床数据.结果 术前合并高脂血症的自肠癌患者201例,血脂正常者181例.高脂血症组患者与正常血脂组患者相比,手术出血量增多（t=11.318,P＜0.01）、术后恢复进食时间（t=5.956,P＜0.01）及拔除引流管时间延长（t=4.781,P＜0.01）、伤口脂肪液化发生率升高（x2=3.988,P＜0.05）,术后住院天数亦增加（t=2.449,P＜0.05）,而手术时间（t=0.374,P＞0.05）及吻合口瘘发生率（x2=0.239,P＞0.05）两者差异无统计学意义.直肠癌接受腹腔镜手术患者,与开腹手术患者相比,手术出血量少（t=10.078,P＜0.01）、术后恢复进食（t=6.366,P＜0.01）及拔除引流管时间短（t=7.654,P＜0.01）、住院天数少（t=4.241,P＜0.01）、伤口脂肪液化发生率低（x2=5.203,P＜0.05）,但手术时间延长（t=8.456,P＜0.01）.接受腹腔镜手术的患者中,高脂血症组患者与正常血脂组患者相比,虽然术中出血仍较多（t=8.784,P＜0.01）,但在术后恢复进食时间（t=0.356,P＞0.05）、术后住院天数（t=0.248,P＞0.05）、拔除引流管时间（t=0.261,P＞0.05）等方面,差异无统计学意义.结论 直肠癌患者术前合并高脂血症会导致手术出血量增加、术后恢复时间延迟、伤口脂肪液化发生率升高,应用腹腔镜技术进行直肠癌根治术可消除因高脂血症所导致的术后恢复延迟.

Objective To study the effect of hyperlipidemia on postoperative complications in patients of colorectal cancer （CRC） undergoing open or laparoscopic surgery. Methods Clinical data of 382 CRC patients who received either traditional or laparoscopic operation from Mar. 2005 to Sep. 2009 were reviewed. By preoperative blood lipid levels, patients were divided into hyperlipidemia group and normal blood lipid group. Data were analyzed by Chi-square test and T test. Results In hyperlipidemia group of 201 CRC cases, volume of blood loss （ t = 11.318, P 〈 0.01 ）, time to resume oral intake（ t =5.956, P 〈 0.01 ）, drainage tube removing （t = 4.781, P 〈 0.01 ）, hospital stay（ t = 2.449, P 〈 0.05 ）, and incidence of wound liquefaction（ x2 =3.988 ,P 〈0.05） were inferior to the other 181 cases in normal blood lipid group, while no difference was observed in operation time （ t = 0.374, P 〉 0.05 ） and incidence of anastomotic leakage（ x2 = 0.239, P 〉 0.05 ）. Patients who received laparoscopic operation had less blood loss （t=10.078 ,P 〈0.01 ）, less time to resume oral intake（t =6.366,P 〈0.01 ） and earlier drainage tube removing （ t = 7.654, P 〈 0.01 ）, shorter hospital stay （ t = 4.241, P 〈 0.01 ） and lower incidence of wound liquefaction （ x2 = 5. 203, P 〈 0.05 ）, though longer operation time （ t = 8.456, P 〈 0.01 ） comparing with those receiving traditional operation. Among patients who received laparoscopic operation, there was no difference observed postoperatively in time to resume oral intake （ t = 0.356, P 〉 0.05 ） and drainage tube removing （t = 0.261, P 〉 0.05 ）, and hospital stay （t = 0.248, P 〉 0.05 ） between the hyperlipidemia group and normal blood lipid group, though the former suffered from more blood loss （t =8.784,P 〈0.01）.Conclusions Hyperlipidemia impacts adversely on hemorrhage, delayed recovery and increasing rate of wound liquefaction on rectal cancer surgery. Laparoscopic surgery effectively eliminates prolonged postoperative recovery caused by hyperlipidemia.