腹腔镜直肠癌根治术对肛肠动力学及抗炎状态的影响

The influence of laparoscopic radical resection for rectal cancer on the anorectal dynamics and anti-inflammatory state

目的:探讨腹腔镜直肠癌根治术对患者肛肠动力学及抗炎状态的影响。方法:收集2012年1月至2013年6月行腹腔镜直肠癌根治术的60例患者(腹腔镜组),纳入同期经检查确认为非直肠癌的60例患者为对照组。对比术前两组患者肛肠动力学指标:肛管静息压(anal resting pressure,ARP)、肛管最大收缩压(anal maximum systolic pressure,MSP)、高压区长度(high-pressure zone length,HPZ)、直肠静息压(rectal resting pressure,RRP)、肛管蠕动波频率(anal peristaltic wave frequency,APWF)、直肠最大耐受容量(maximal tolerable rectal volume,MTV)、直肠肛管抑制反射阈值(anorectal inhibitory reflex threshold,AIRT)。并比较腹腔镜组患者术前及术后第1天、第7天、第15天血清炎症指标水平。结果:两组患者间各项肛肠动力学指标差异均无统计学意义(P>0.05)。术后第15天,腹腔镜组ARP、MSP、HPZ、MTV显著下降(P<0.05),而RRP、AIRT则显著上升(P<0.05),APWF无明显改变。从术后第1个月开始,各项指标逐渐恢复,术后第3、6个月各项指标与术前相比差异均无统计学意义。术后第1天腹腔镜组血清炎症因子白介素-6、白介素-8、肿瘤坏死因子-α、C反应蛋白、血清淀粉样蛋白A水平显著高于术前(P<0.05);术后第7天开始各项指标逐渐恢复,术后第15天各项指标与术前相比差异无统计学意义。结论:腹腔镜直肠癌根治术对患者肛肠动力学具有短期、暂时的影响,术后3个月肛肠动力学可恢复正常;术后患者体内发生剧烈的抗炎反应,术后第15天恢复正常。

Objective： To investigate the influence of laparoscopic radical resection for rectal cancer on the anorectal dynamics and anti-inflammatory state. Methods： Sixty patients with rectal cancer from Jan. 2012 to Jun. 2013 were selected as laparoscopic group,then 60 patients of non-colorectal cancer in the same period were included as control group. The indexes of preoperative anorectal dynamic such as anal resting pressure（ ARP）,anal maximum systolic pressure（ MSP）,high pressure zone length（ HPZ）,rectal resting pressure（ RRP）,anal peristaltic wave frequency（ APWF）,maximal tolerable rectal volume（ MTV）,anorectal inhibitory reflex threshold（ AIRT） of two groups were compared,the serum levels of inflammatory markers before operation and on the postoperative 1,7 and15 d were also compared. Results： There were no statistical differences in indexes of anorectal dynamic between laparoscopic group and control group（ P〉0. 05）. On the 15 d after surgery,the indexes such as ARP,MSP,HPZ and MTV of laparoscopic group were significantly decreased,while the RRP and AIRT were significantly increased（ P〈0. 05）,no obvious changes of APWF were found. From the first month after surgery,the indicators began to recover,in the third and sixth month after surgery,the indicators were not significantly different compared to those before surgery. On the first day after surgery,the serum levels of inflammatory markers such as interleukin-6（ IL-6）,interleukin-8（ IL-8）,tumor necrosis factor-α（ TNF-α）,C-reactive protein（ CRP） and serum amyloid A（ SAA） were significantly increased（ P〈0. 05）; from the 7th day after surgery,these indicators began to recover,and in the 15 th day after surgery,there was no significant difference compared to those before surgery. Conclusions： The influence of laparoscopic radical resection for rectal cancer on the anorectal dynamics is short-term and temporary,the anorectal dynamics can be restored to normal 3 months after surgery,the anti-inflammatory response is agrius,and can be restored to normal 15 d after surgery.