快速康复外科对腹腔镜结直肠癌手术老年患者miR-21、VEGF、MMP-9、炎症因子及胃肠功能的影响

Effect of rapid rehabilitation surgery on miR-21,VEGF,MMP-9, inflammatory factors and gastrointestinal function in elderly patients undergoing laparoscopic colorectal cancer operation

[目的]探讨快速康复外科对腹腔镜结直肠癌手术老年患者miR-21、血管内皮生长因子(vascular endothelial growth factor, VEGF)、基质金属蛋白酶(Matrix metalloproteinase, MMP)-9、炎症因子及胃肠功能的影响。[方法]选择结直肠癌老年患者144例作为研究对象,按照随机数字表法把患者均分为观察组、对照组各72例;对照组给予术后常规护理,观察组给予术后快速康复外科护理;记录2组患者miR-21、VEGF、MMP-9、炎症因子及胃肠功能变化情况。[结果]观察组术后首次排气时间、首次排便时间、肠鸣音恢复时间与住院时间都显著少于对照组(P<0.01)。观察组术后14 d的吻合口瘘、肺部感染、肠梗阻、切口感染、静脉血栓等并发症发生率为4.2%,显著低于对照组的19.4%(P<0.01)。观察组术后7 d、14 d的血清VEGF、MMP-9、IL-4、IL-17值都显著低于对照组(P<0.01)。观察组术后7 d、14 d的全血miR-21相对表达水平显著低于对照组(P<0.01)。所有患者术后随访3个月,观察组的胃肠功能紊乱发生率为1.4%,显著低于对照组的12.5%(P<0.01)。[结论]快速康复外科在腹腔镜结直肠癌手术老年患者中的应用能抑制miR-21、VEGF、MMP-9、IL-4与IL-17的表达,促进患者恢复胃肠功能,减少术后并发症的发生,降低胃肠功能紊乱发生率。

[Objective]To investigate the effects of rapid rehabilitation surgery on miR-21,vascular endothelial growth factor(VEGF),matrix metalloproteinase(MMP)-9,inflammatory factors and stomach bowel function in elderly patients undergoing laparoscopic colorectal cancer surgery.[Methods]From December 2016 to June 2019,144 patients with colorectal cancer admitted to our hospital were selected as the study subjects and were randomly divided into the observation group and control group accorded to the random number table method.The control group was given routine postoperative care, and the observation group was given postoperative rapid rehabilitation surgical care.The changes of miR-21,VEGF,MMP-9,inflammatory factors and gastrointestinal function were recorded in the two groups.[Results]The postopeartive first exhaust time, first defecation time, bowel sound recovery time and hospital stay in the observation group were significantly lower than in the control group(P<0.01).The postoperative 14 d of incidences of complications such as anastigmatic leakage, pulmonary infection, intestinal obstruction, wound infection, and venous thrombosis were 4.2% in the observation group, which were significantly lower than that in the control group(19.4%,P<0.01).The postoperative 7 d and 14 d of serum levels of VEGF,MMP-9,IL-4 and IL-17 in the observation group were significantly lower than those in the control group(P<0.01).The relative expression levels of miR-21 in whole blood of the observation group were significantly lower than those of the control group at 7 and 14 days after operation(P<0.01).All patients were followed up for 3 months, the incidences of gastrointestinal dysfunction in the observation group were 1.4%,which were significantly lower than that in the control group(12.5%,P<0.01).[Conclusion]Rapid rehabilitation surgery can inhibit the expression of miR-21,VEGF,MMP-9,IL-4 and IL-17 in elderly patients undergoing laparoscopic colorectal cancer surgery, and promote the recovery of gastrointestinal function and reduce postoperative complications.It also can reduces the incidence of gastrointestinal disorders.