腹腔镜直肠癌根治术气腹及腹壁切口长度对血浆血管内皮生长因子水平的影响及其临床意义

The effects and clinical significance of pneumoperitoneum pressure during laparoscopic radical resection of rectal carcinoma and length of accessorial incision of abdominal wall on plasma levels of vascular endothelial growth factor

目的:探讨腹腔镜直肠癌根治术(laparoscopic radical resection,LR)CO2气腹压力、腹壁辅助切口长度对血浆血管内皮生长因子(vascular endothelial growth factor,VEGF)水平的影响及其临床意义。方法:入选患者88例,其中51例行腹腔镜手术(LR组),腹腔镜组内根据腹壁切口长度、气腹压力又分为腹壁长切口、高压力组(LR-Ⅰ组,n=21)与短切口、低压力组(LR-Ⅱ组,n=30);37例行开腹结肠癌根治术(open radical resection,OR,OR组)。采用酶联免疫组化法检测3组患者手术前后不同时段血浆VEGF水平,并进行组间同一时段、组内不同时段的对比。结果:术后腹壁切口平均长度方面,OR与LR组相比、LR-Ⅰ组与LR-Ⅱ组相比差异均有统计学意义(P<0.05)。术前3组患者VEGF水平差异无统计学意义(P>0.05)。术后VEGF水平3组患者均有所升高;自术后第3天,OR组与LR组患者同一时段相比差异有统计学意义(P<0.05);LR-Ⅰ组与LR-Ⅱ组相比差异无统计学意义(P>0.05)。与术前相比,LR组仅术后第7天差异有统计学意义(P<0.05),余差异均无统计学意义(P>0.05);而OR组术后第1天至第7天差异均有统计学意义(P<0.05)。结论:腹腔镜及开腹结直肠癌根治术后VEGF水平均有所升高,但腹腔镜组升幅低于开腹组;LR-Ⅰ组与LR-Ⅱ组的手术切口、气腹压力对VEGF水平的影响差异无统计学意义(P>0.05)。腹腔镜直肠癌根治术是安全、可行的。

Objective ： To investigate the effects and clinical significance of CO2 pneumoperitoneum pressure during laparoscop- ic radical resection of rectal carcinoma and length of accessorial incision of abdominal wall on plasma levels of vascular endothelial growth factor （VEGF）. Methods：The study included 88 cases of radical resection of rectal carcinoma,there were 21 cases in long ab- dominal wall incision and high pressure group （LR-1） ,30 cases in short abdominal wall incision and low pressure group （LR-2） and 37 cases in open rectal surgery group （OR）. Enzyme-linked immunohistochemistry was conducted to detect the level of VEGF of the three groups before and after operation in different periods, the level of VEGF were compared between groups in the same period and in a group at different periods. Results ： There was significant difference between LR group and OR group, and between LR-1 group and LR-2 group on average length of incision of abdominal wall （ P 〈 0.05 ）. The level of VEGF of the three groups was increased signifi- cantly after operation. There was no significant difference among the three groups before operation and the first day after operation （ P 〉 0.05 ）. There was significant difference between OR group and LR group in the same period of time from the third day after operation （ P 〈 0.05 ）, whereas there was no significant difference between the two LR groups （ P 〉 0.05 ）. There was significant difference in the two LR groups between one day before and the seventh day after operation （ P 〈 0.05 ） , whereas there was significant difference at the first day, third day and the seventh day after operation in the OR group compared with preoperative data （ P 〈 0.05 ）. Conclusions ： The expression of VEGF increases after LR and OR, and the level of VEGF in patients who underwent LR is lower than those of OR. There is no significant difference on the level of VEGF in the long or short abdominal wall incision and high or low pressure group （P 〉 0.05 ） , and the laparoscopic radical resection of rectal carcinoma is as safe as the traditional open surgery and feasible.