腹腔镜直肠癌根治术对老年直肠癌患者的疗效、胃肠功能及术后血清CRP、TNF-α、IL-6、胃动素和胃泌素的影响

Effect of Laparoscopic Radical Resection of Rectal Cancer on the Efficacy,Gastrointestinal Function and Serum CRP,TNF-alpha,IL-6,Motilin and Gastrin in Elderly Patients with Rectal Cancer

目的目的探讨腹腔镜直肠癌根治术对老年直肠癌患者的疗效、胃肠功能及术后血清CRP、TNF-α、IL-6、胃动素和胃泌素的影响。方法选取行直肠癌根治术治疗的老年直肠癌患者143例,根据其手术方法不同分为腹腔镜组87例和开腹组56例。在术前1天,术后第1、3、7天采集患者空腹静脉血。采用ELISA法检测血清CRP、TNF-α、IL-6、胃动素和胃泌素。观察比较2组手术情况,胃肠功能恢复情况,血清RP、TNF-α、IL-6、胃动素和胃泌素及并发症等情况。结果腹腔镜组在手术时间和淋巴结清除数量均较开腹组多,差异有统计学意义(P<0.001);腹腔镜组在术中出血量、切口总长、术后吗啡用量、术后镇痛时间、下床活动时间、住院时间均较开腹组少,差异有统计学意义(P<0.001)。术后第1、3、7天腹腔镜组血清CRP、TNF-α、IL-6、胃动素和胃泌素水平均较开腹组低,差异有统计学意义(P<0.001);腹腔镜组在腹胀维持时间、肛门排气时间、肠鸣音恢复时间、开始进食时间均较开腹组短,差异有统计学意义(P<0.001)。腹腔镜组术后并发症发生率为9.20%,少于开腹组(33.92%),差异有统计学意义(P<0.01)。结论腹腔镜直肠癌根治术对老年直肠癌患者机体创伤较小,可以减少术中出血量,有利于患者胃肠功能的恢复,降低术后并发症发生率。

Objective To investigate the effect of laparoscopic radical resection of rectal cancer in elderly patients with rectal cancer,gastrointestinal function and postoperative serum CRP,TNF-alpha,IL-6,motilin and gastrin. Methods 143 elderly patients with colon cancer treated with radical resection,according to the different surgical methods were divided into laparoscopic group（ 87 cases） and the laparotomy group（ 56 cases）,1 d before operation 1,3,7 d after operation were collected fasting venous blood. Serum CRP,TNF-alpha,IL-6,gastrin and motilin were detected by ELISA,were compared between the two groups of surgery,recovery of gastrointestinal function,serum RP,TNF-alpha,IL-6,gastrin and motilin and complications of the 2 groups were compared. Results There was a significant difference in the operation time and the number of lymph nodes clearance between laparoscopic group and laparotomy group（ P 〈 0. 001）. In the laparoscopic group,the amount of bleeding,incision length,postoperative morphine consumption,postoperative analgesia time,ambulation time,hospital stay were lower than those of the open group,the difference was statistically significant（ P 〈 0. 001）. The CRP,TNF-α,IL-6,motilin and gastrin levels 1 d,3 d and 7 d after operation in the laparoscopic group were lower than those of the laparotomy group,the difference was statistically significant（ P 〈 0. 001）. Maintain time,anal exhaust time,bowel sound recovery time,abdominal distension in eating time in the laparoscopic group were lower than the laparotomy group,the difference was statistically significant（ P 〈 0. 001）. The incidence of postoperative complications in laparoscopic group was 9. 20%,lower than that of the open surgery group（ 33. 92%）,and the difference was statistically significant（ P 〈 0. 01）. Conclusion Laparoscopic radical resection of rectal cancer in elderly patients with rectal cancer is less traumatic,can reduce the amount of intraoperative bleeding,is conducive to the recovery of gastrointestinal function,and can reduce the incidence of postoperative complications.