腹腔镜与开放结直肠癌根治术对机体应激反应的影响

Clinical comparative study of laparoscopic and open surgery for colorectal cancer in the body' s stress response

目的:分析腹腔镜与开放结直肠癌根治术对机体应激反应的影响。方法:选择80例结直肠癌患者,随机分为实验组和对照组,各40例。实验组患者给予腹腔镜结直肠癌根治术治疗,对照组患者则采用幵放结直肠癌根治术诊治。分析两组患者手术前后血清中IL-6、TNF-α、CRP以及ghrelin水平的变化;比较两组患者术前及术后外周静脉血血糖(BG)、胰岛素(Ins)、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、促甲状腺激素刺激激素(TSH)以及皮质醇(CS)的变化;观察两组患者的手术时间、术中出血量、住院时间、肠蠕动恢复时间以及并发症的差别。结果:术前1d,两组患者的IL-6、TNF-α、CRP以及ghrelin水平无差异性(P>0.05),实验组患者在术后1h、术后1d、术后3d的血清指标水平均显著低于对照组患者,具有显著性差异(P<0.05)。术前1d以及术后1d,两组患者的BG、Ins、T3、T4、TSH以及CS的水平无差异性(P>0.05),术后2d,实验组患者除TSH外其他指标与对照组比较,均存在明显差异性,具有统计学意义(P<0.05)。实验组患者的手术时间、术中出血量、住院时间以及肠蠕动恢复时间均显著低于对照组患者,具有统计学意义(P<0.05)。两组患者术后发生并发症的例数无差异性(P>0.05)。结论:腹腔镜结直肠癌根治术对患者的应激反应影响明显小于开放结直肠癌根治术,具有出血少、康复快、住院时间短、肠蠕动恢复时间快等优势,值得临床推广使用。

Objective：To analyze the laparoscopic and open surgery for colorectal cancer effects on the body＇s stress response. Methods ： All 80 cases of colorectal cancer patients were randomly divided into experimental and con- trol groups ,40 cases each. The experimental group were treated with laparoscopic resection of colorectal cancer treat- ment, the patients in the control group were used Jian put resection of colorectal cancer treatment. To analyze IL - 6, TNF-α,CRP and changes in serum ghrelin levels before and after surgery, peripheral blood glucose （BG）, insulin （ Ins）, three iodine thyroid original acid （ T3 ） , four - triiodothyronine （ T4）, thyroid stimulating hormone - stimulating hormone （TSH） and cortisol （CS）also operative time, blood loss, hospital stay, bowel motility recovery time difference and complications. Results：Preoperative l d, two groups of patients IL- 6, TNF- α, CRP and ghrelin levels had no difference （P 〉 0.05 ）, patients in the experimental group 1 h, after 1 d, 3d postoperative levels of serum markers of postoperative were significantly lower than the control group （ P 〈 0.05 ）. Preoperative and postoperative 1 d, BG, Ins, T3, T4, TSH levels and CS had no difference （P 〉 0.05 ） , after the 2d, the patients in the experimental group and the control group compared with other indicators in addition to TSH （ P 〈 0.05 ）. In the experimental group were signifi- cantly operative time, blood loss, hospital stay time and bowel recovery time were significantly lower than the control group （P 〈 0. 05 ）. Number of cases of postoperative complications was almost the same, no difference （ P 〉 0.05 ）. Conclusion：The stress response affects laparoscopic resection of colorectal cancer patients was significantly less than open surgery, with less bleeding, faster recovery, shorter hospital stay, faster recovery time of bowel movements and other advantages.