术中腹内压增加对大肠癌微创手术患者消化系统影响的研究

Impact of increasing intra-abdominal pressure on digestive system during colorectal cancer patients under minimally invasive surgical procedure

目的探究术中腹内压增加对大肠癌微创手术患者消化系统的影响。方法回顾性分析2013年1月-2016年6月该院收治的132例经腹腔镜大肠癌根治手术治疗的大肠癌患者的临床资料。根据患者术中采用的腹内压将患者分为A组、B组和C组。A组46例患者为10 mm Hg(1 mm Hg=0.133 k Pa),B组45例患者为12 mm Hg,C组41例患者为15 mm Hg。比较3组患者术后各项恢复时间、并发症情况和血清细胞因子水平。结果 3组患者术后6 h内拔出鼻胃管例数、肠蠕动恢复时间、首次肛门排气或排便时间、耐受半流质饮食时间、术后腹泻持续时间和术后住院时间差异均无统计学意义(P>0.05)。术后3组患者急性胃肠损伤(AGI)、乳糜漏、吻合口瘘、术区渗血、肠麻痹和术后呕吐发生率差异均无统计学意义(P>0.05)。术后3组患者的白细胞介素-6(IL-6)和平均动脉压(MAP)较术前均明显升高,差异有统计学意义(P<0.05)。术前3组患者的肿瘤坏死因子-α(TNF-α)较术后差异无统计学意义(P>0.05)。术后25例肠麻痹患者血清IL-6水平为(10.71±4.37)ng/L,107例未发生肠麻痹患者的血清IL-6水平为(10.66±4.13)ng/L,差异无统计学意义(P>0.05)。结论术中腹内压增加对大肠癌微创手术患者消化系统没有显著影响。

Objective To investigate the impact of intraoperative intra-abdominal pressure increasing on digestive system. Methods A retrospective analysis of clinical data of 132 cases of colorectal cancer patients from January 2013 to June 2016 was made. Patients were divided into groups A, B and C according to the intra-abdominal pressure, 46 cases in each group. Group A: 46 patients, 10 mmHg (1 mmHg = 0.133 kPa), group B: 45 patients, 12 mmHg, group C: 41 patients, 15mmHg. Comparison of postoperative recovery time, complications, serum cytokine levels was made among the three groups. Results The number of postoperative 6h nasogastric tube pulled out,bowel recovery time, first flatus or a bowel movement, tolerance semi-liquid diet, postoperative duration of diarrhea,postoperative hospitalization time among the three groups show no statistically difference (P > 0.05). The difference of acute gastric injury (AGI), chyle leakage, anastomotic fistula, surgical bleeding, intestinal paralysis, vomiting incidence of postoperative among the three groups has no statistically differences (P > 0.05). While postoperative IL-6 level and MAP were significantly increased compare with preoperative level, the difference was statistically significant (P < 0.05). Postoperative TNF-α show no statistical differences compare with preoperative (P > 0.05).Postoperative serum IL-6 levels in 25 patients with intestinal paralysis was (10.71 ± 4.37) ng/L, 107 cases had high serum IL-6 levels in patients did not occur intestinal paralysis was (10.66 ± 4.13) ng/L, the difference was not statistically significance (P > 0.05). Conclusion Intra-abdominal pressure increasing during minimally invasive surgical procedure has no significant effect on the digestive system in colorectal cancer patients.