腹腔镜下大肠癌根治术中腹内压升高对患者治疗效果影响的考察

Effect of increasing intra-abdominal pressure on patient 's prognosis during laparoscopic radical surgery for colorectal cancer

目的探讨腹腔镜下大肠癌根治术中腹内压升高对其预后的影响。方法回顾性分析2014年1月至2017年6月收治的114例腹腔镜下大肠癌根治术患者的临床资料,按照术中不同气腹压分为A、B和C三组:A组,术中腹内压为10 mm Hg,36例;B组术中腹内压为12 mm Hg,41例;C组术中腹内压为15 mm Hg,37例。数据采用SPSS 20.0统计软件进行分析,比较三组患者术后各项指标、外周血内D-乳酸、IL-6及TNF-α水平以(x±s)表示,组间对比采用t检验。各组患者术后6 h内鼻胃管拔出率及并发症发生情况组间对比采用χ~2检验,以P<0.05表示差异具有统计学意义。结果三组患者术后6 h内鼻胃管拔出率、首次排气时间、首次排便时间、首次肠鸣音时间、首次进食时间以及术后住院时间相比,差异均无统计学意义(P>0.05)。三组患者术后并发症发生率相比,差异均无统计学意义(P>0.05)。与术前相比,三组患者的D-乳酸和白细胞介素-6(IL-6)均明显升高,差异有统计学意义(P<0.05);TNF-α水平无显著变化(P>0.05)。术后C组的D-乳酸水平显著高于A、B组,差异有统计学意义(P<0.05)。结论腹腔镜下大肠癌根治术中腹内压升高对患者的预后没有影响。

Objective To explore the effect of increasing intra-abdominal pressure on patient＇ s prognosis during laparoscopic radical surgery for colorectal cancer. Methods A retrospective analysis of clinical data of ll4 cases of eolorectal cancer patients undergoing laparoscopie radical resection in our hospital from January 2014 to June 2017 was made. According to the different intra-abdominal pressure, patients were divided into 3 groups： Group A： 10 mmnHg （ 1 mmHg =0. 133 kPa） , 36 cases; group B： 12 mmHg, 41 cases; group C： 15 mmHg, 37 cases. All data were analyzed by SPSS 20.0 statistical software. The postoperative recovery conditions and the peripheral blood D-lactic acid, IL-6 and TNF-α level were presented as （x ＋ s ） and examined by t test. The proportion of pulling out nasogastric tube within 6 h after operation and the incidence of postoperative complications were compared among three groups by chi square. Results There was no statistical difference in the proportion of pulling out nasogastrie tube within 6 h after operation, first exhaust time, first defecation time, first bowel sounds time, first meal time and hospitalization lime in the three groups （P 〉 0. 05 ）. There was no statistically significant difference in the incidence of postoperative complications in the three groups （P 〉 0. 05 ）. Compared with preoperative, the postoperative D-lactic acid and IL-6 level were signi？ cantly increased （ P 〈 0.05 ）, but the postoperative TNF-α level has no significant change （P 〉 0.05）. The postoperative D-lactic acid level in group C were significantly higher than group A and B （ P 〈 0. 05 ）. Conclusion The increasing intra-abdominal pressure during laparoscopic radical surgery for colorectal cancer has no significant effect on patient＇ s prognosis.