腹腔镜微创手术对结直肠癌患者血浆ACTH、COR水平和并发症的影响

the plasma ACTH,COR level and complication influence of laparoscopic minimally invasive surgery in patients with colorectal cancer

目的探讨腹腔镜微创手术对结直肠癌患者血浆促肾上腺皮质激素(ACTH)、皮质酮(COR)水平和并发症的影响。方法选取2011年12月至2013年12月青海省第五人民医院确诊治疗的结直肠癌患者100例,依据随机分配原则分为微创组和常规组,每组50例,常规组患者给予常规开腹根治术治疗,微创组患者给予腹腔镜微创手术治疗,采用酶联免疫吸附法(ELISA)检测血浆ACTH、COR水平,随访3年,统计分析所有患者淋巴结清扫、术中出血量、胃功能恢复、住院时间、并发症、生存和术前术后血浆ACTH、COR水平。结果微创组患者术中出血量、胃功能恢复、住院时间和并发症发生率明显低于常规组,差异有统计学意义(P<0.05),但两组淋巴结清扫数基本相同,差异无统计学意义(P>0.05)。微创组和常规组患者术后血浆ACTH、COR水平均较术前上升,但前者较后者上升更显著,差异有统计学意义(P<0.05);微创组和常规组患者1、2、3年累积生存率基本相同,差异无统计学意义(P>0.05)。结论腹腔镜微创手术治疗结直肠癌的近远期疗效确切,可有效降低患者术中创伤和术后应激反应、并发症发生,有利于患者身体恢复,值得临床作进一步推广。

Objective To discuss the plasma adrenocorticotropic hormone (ACTH),corticosterone (COR) level and complication influence of laparoscopic minimally invasive surgery in patients with colorectal cancer. Methods 100 patients with colorectal cancer were selected from December 2011 to December 2013 in our Hospital.According to the random distribution,all patients were divided into minimally invasive group and routine group,50 cases in each group,routine group patients were given conventional laparotomytreatment,minimally invasive group patients were given laparoscopic minimally invasive surgery treatment,enzyme-linked immunosorbent (ELISA) was used to detect the plasma levels of ACTH,COR,followed up of 3 years,statistical analyzed all patients with lymph node cleaning,intraoperative blood loss,stomach function,length of hospital stay,complications and survival and preoperative postoperative serum ACTH,COR levels. Results The intraoperative blood loss,stomach function,length of hospital stay,complication rate of minimally invasive group patients were significantly lower than those of routine group,the difference was statistically significant ( P <0.05),but the lymph node cleaning number of two group were basic same,there was no statistically significant difference ( P >0.05).The postoperative serum ACTH,COR levels of minimally invasive group and routine group patients compared with preoperative were rise,but the former were more significantly rise than the latter,the difference was statistically significant ( P <0.05).The 1,2,3 years cumulative survival rates of minimally invasive group and routine group patients were basic same,there was no statistically significant difference ( P >0.05). Conclusion Laparoscopic minimally invasive surgery has good near and forward future efficacy for colorectal cancer,it can effectively decrease the intraoperative and postoperative trauma patients with stress reaction,complications,and it is beneficial to patients recovery,it's worth for further clinical promotion.