老年直肠癌患者运用小切口开腹手术的机体应激反应

Trauma Induced Stress Response after Mini-laparotomy for Rectal Carcinoma in Elderly Patients

目的比较小切口和开腹直肠癌根治术对老年患者全身应激反应的影响.方法按标准回顾性纳入2007年2月至2009年12月期间接受治疗的患者278名.按照年龄将所有患者分为老年组(年龄≥60岁,A组)和非老年组(年龄<60岁,B组);两组根据开腹切口的长度将患者划分为小切口组和标准切口组.于术前3 d和术后1 d采集患者静脉血,测定C-反应蛋白(C-reactive Protein,CRP)和血清淀粉样蛋白(SerumAmyloid A,SAA)水平,并比较手术安全性、术后并发症和恢复情况.结果小切口患者术后1 d的血清CRP和SAA炎症因子水平低于开腹组,但差异没有统计学意义(P>0.05),较术前增幅的差异也没有统计学意义(P>0.05);行小切口的患者术后首次排便的时间早于行标准切口的患者(P<0.05);不同年龄患者术后并发症的发生率没有区别(P>0.05).结论老年患者运用小切口手术获得创伤反应的下降,创造了更为安全的近期效果,降低术后手术风险.

Objective To compare the alteration of trauma induced stress reaction after the minilaparotomy and conventional open surgery in elderly patients with rectal carcinoma.Methods 278 patients with rectal carcinoma were retrospectively enrolled from February 2007 to December 2009,and divided into group A（106 cases）with age60 years old and group B（172 cases）with age60 years old.Two main groups were subdivided by different kinds of surgery approach to resection of recta carcinoma（minilaparotomy and conventional open surgery）.Inflammatory responses were evaluated with C-reactive protein（CRP）and Serum Amyloid（SAA）in peripheral bood on the three days before the operation and one day after the operation.Perioperative status and complication incidence were also compared.Results Serum levels of CRP and SAA were increased markedly on the 1st day after the operation in all groups,but the levels of CRP and SAA in groups with minilaparotomy were significantly lower than those with conventional open surgery（P〈0.05）,and the amplification of CRP and SAA after and before the operation were considerably lower in minilaparotomy group（P〈0.05）.First time for defecation in minilaparotomy groups were less than in the conventional open surgery group.In aged patients,the incidence rate of complication was much lower in the minilaparotomy group（P〈0.05）.Conclusions Minilaparotomy resection of rectal carcinoma results in less trauma induced stress response compared to open surgery in aged patients.It benefits the restoration after operation in short term,and reduce the risk of operation effectively.