腹腔镜治疗老年结直肠癌术后肠梗阻对血清肌酸激酶和D-二聚体的影响

Effect of laparoscopic colorectal surgery on serum creatine kinase and D-dimer in elderly patients with colorectal obstruction

目的对比分析腹腔镜与开腹手术治疗老年结直肠癌术后早期肠梗阻的发生情况以及血清肌酸激酶(CK)和D-二聚体(D-dimer)的变化意义。方法回顾性分析广安市人民医院2014年1月至2017年1月诊治的130例老年结直肠癌患者临床资料,分析患者经腹腔镜治疗(腹腔镜组,60例)和常规开腹手术治疗(开腹组,70例)后肛门排气时间、住院天数和肠梗阻的发生率,并采用肌酸显色法检测不同手术患者治疗前后血清CK水平变化,酶联免疫吸附测定法检测两组治疗前后D-dimer的水平变化。结果(1)与开腹组相比,腹腔镜组患者左半结肠癌根治术、右半结肠癌根治术和直肠癌根治术的手术时间及术中出血量明显降低,术后肛门排气时间及住院天数均明显缩短,肠梗阻总发生率明显降低(均P<0.05)。(2)腹腔镜组术后发生肠梗阻4例(6.7%),开腹组术后发生肠梗阻13例(18.6%),腹腔镜组患者肠梗阻总发生率以及左半结肠癌根治术后肠梗阻发生率较开腹组明显降低,差异有统计学意义(χ^2=4.028、4.409,P=0.045、0.036)。(3)治疗后两组患者血清CK和D-dimer水平均明显降低,且腹腔镜组治疗后CK和D-dimer水平均显著低于开腹组,差异有统计学意义(P<0.01)。(4)肠梗阻患者CK和D-dimer水平显著高于未发生肠梗阻患者的水平,差异有统计学意义(t=9.235、13.877,均P<0.01)。(5)肠梗阻患者CK和D-dimer水平变化呈明显正相关性(r=0.852,P=0.012)。结论老年腹腔镜结直肠术后肠梗阻发生率低,患者术后恢复更快,检测血清CK和D-dimer水平降低程度可以为临床更合理的治疗提供参考。

Objective To compare the incidence of early intestinal obstruction after laparoscopic and open surgery for elderly patients with colorectal cancer, and the significance of serum creatine kinase(CK) and D-dimer. Methods From January 2014 to January 2017, the clinical data of 130 elderly patients with colorectal cancer treated in Guang’an City People’s Hospital were retrospectively analyzed. The time of anal exhaust, hospitalization days and incidence of intestinal obstruction were compared between laparoscopic treatment(laparoscopic group, 60 cases) and conventional laparotomy(open group, 70 cases). Serum CK levels were measured by creatine colorimetry and D-dimer levels were measured by enzymelinked immunosorbent assay before and after treatment in the two groups. Results(1) Compared with the open group, operation time and bleeding volume of the laparoscopic group were significantly reduced in the left hemicolon cancer radical operation, the right hemicolon cancer radical operation and the rectal cancer radical operation. The time of anal exhaust and hospitalization stay were significantly shortened, and the incidence of total intestinal obstruction was significantly reduced in the laparoscopic group(all P<0.05).(2) Intestinal obstruction occurred in 4 cases(6.7%) in laparoscopic group and 13 cases(18.6%) in open group. The incidence of total intestinal obstruction and intestinal obstruction after radical resection of left colon cancer in laparoscopic group were significantly lower than those in open group, with significant differences(χ^2=4.028, 4.409, P=0.045, 0.036).(3) Serum CK and D-dimer levels were significantly lower in both groups after treatment, and CK and D-dimer levels in laparoscopic group were significantly lower than those in open group after treatment(P<0.01).(4) The levels of CK and D-dimer in patients with intestinal obstruction were significantly higher than those in patients without intestinal obstruction(t=9.235, 13.877, both P<0.01).(5) There was significant positive correlation between CK and D-dimer in patients with intestinal obstruction(r=0.852, P=0.012). Conclusions Elderly patients with intestinal obstruction after laparoscopic colorectal surgery have the advantages of lower incidence and faster recovery. Detection of serum CK and D-dimer levels can provide reference for more reasonable clinical treatment.