腹腔镜下直肠癌手术术后高凝状态及内皮损伤情况观察

Observation of hypercoagulability and endothelial injury after laparoscopic rectal cancer surgery

目的研究腹腔镜下直肠癌手术术后高凝状态及内皮损伤情况。方法根据手术方式的不同将160例直肠癌患者分为传统组与腹腔镜组,传统组76例,行传统开腹直肠癌手术;腹腔镜组84例,行腹腔镜下直肠癌手术。观察两组患者高凝状态指标及血管内皮损伤相关指标。结果术后1天,传统组与腹腔镜组患者D-二聚体(D-D)、蛋白C(Pro-C)、重组凝血酶原片段1+2(F1+2)、内皮素-1(ET-1)、血管性假血友病因子(vWF)、凝血调节蛋白(TM)水平均高于本组术前,且腹腔镜组患者D-D、F1+2水平均高于传统组,差异均有统计学意义(P﹤0.05)。术后,两组患者血管内皮生长因子(VEGF)水平均高于本组术前,且随着术后时间延长,不断升高;术后1、5、10、20天,腹腔镜组患者VEGF水平均低于传统组,差异均有统计学意义(P﹤0.05)。结论相较于传统开腹直肠癌手术,行腹腔镜下直肠癌手术患者术后血液呈高凝状态,内皮细胞一定程度受到损伤。

Objective To evaluate the occurrence of hypercoagulability and endothelial injury after laparoscopic rectal cancer surgery.Method A total of 160 cases with rectal cancer were included in the study and were categorized as per different surgical procedures administered into traditional group and laparoscopic group.For the 76 cases in traditional group,conventional laparotomy was performed for rectal cancer resection,while laparoscopic surgery was administered in 84 patients in the laparoscopic group.The related measures for hypercoagulability and vascular endothelial injury were observed in both groups.Result In one day after surgery,the D-dimer(D-D),protein C(Pro-C),recombinant prothrombin fragment1+2(F1+2),endothelin-1(ET-1),von Willebrand factor(vWF)and thrombomodulin(TM)levels in traditional group and laparoscopic group were all increased significantly compared to those before surgery;furthermore,the D-D and F1+2 levels in laparoscopic group were significantly higher than those in traditional group(P<0.05).The level of vascular endothelial growth factor(VEGF)were increased in both groups after surgery,and elevated as the time after surgery elapsed;the VEGF level in laparoscopic group were generally lower compared to traditional group in 1,5,10,20 days after surgery(P<0.05).Conclusion Compared with patients treated with traditional open surgery for rectal cancer resection,those patients who were administered with laparoscopic surgery may develop postoperative hypercoagulability,with the presence of damaged endothelial cells.