高龄患者腹腔镜结直肠癌根治术对机体应激及内脏蛋白的影响  

Operative stress response and visceral proteins after laparoscopic radical resection of colorectal carcinoma of aged patient

作　　者：律玉臣[1] 张建立[1] 周召海[2] 孙振青[1] 

机构地区：[1]青岛大学医学院附属医院东区,山东青岛266003 [2]平度市人民医院

出　　处：《腹腔镜外科杂志》2010年第4期275-279,共5页Journal of Laparoscopic Surgery

摘　　要：目的:研究高龄患者腹腔镜与开腹结直肠癌根治术围手术期IL-6、IL-10和C反应蛋白(C-reactive protein,CRP)及内脏蛋白的差异。方法:按患者意愿将41例行结直肠癌根治术的高龄患者分为腹腔镜组(n=20)和开腹组(n=21),两组患者的年龄、性别、体重指数(BMI)等差异无统计学意义,具有可比性,检测两组患者术前、术后的应激指标:血清IL-6、IL-10、CRP及内脏蛋白:前白蛋白(prealbumin,PRE)、转铁蛋白(transferrin,TRF)、视黄醇结合蛋白(retinal-binding protein,RbP)的变化。结果:两组患者CRP在术后1、2、3d均较术前明显升高(P<0.01),术后第2天达峰值,腹腔镜组术后CRP明显低于开腹组(P<0.01);两组患者血清IL-6、IL-10术后明显升高,腹腔镜组明显低于开腹组(P<0.01),IL-10升高持续时间短。术后两组PRE、TRF、RbP均较术前明显下降(P<0.01),术后1、2d两组各项指标差异无统计学意义(P>0.05),术后第3天腹腔镜组4种蛋白指标均明显高于开腹组(P<0.01)。结论:本组高龄患者术后应激水平及内脏蛋白指标的结果显示,腹腔镜结直肠癌根治术较开腹手术创伤小,应激水平低,有利于机体内脏蛋白的恢复,这对实施微创外科是有力的支持。Objective：To compare the differences of perioperative C-reactive protein （CRP）,interleukin-6（IL-6）,IL-10 and visceral proteins in laparoscopic and open radical resection of colorectal carcinoma for aged patients.Methods：According to patients＇ choice,laparoscopic （n=20） and open （n=21） radical resection of colorectal carcinoma were performed.There were no significantly statistical difference in age,sex and BMI of patients in 2 groups.The stress index of the 2 groups：IL-6,IL-10,CRP and visceral protein which included prealbumin（PRE）,transferrin（TRF） and retinal-binding protein（RbP） were assayed preoperatively and at the 6h,1st,2nd and 3rd day postoperatively.Results：CRP levels in both groups increased at the 1st,2nd and 3rd day postoperatively compared to the preoperative period（P0.01）and reached the peak level at the 2nd day postoperatively,the response in the laparoscopic group was much less （P0.01）.The plasma levels of IL-6 and IL-10 were significantly increased after the operation in both groups.However,it was lower in the laparoscopic group（P0.01）.The increasing time of IL-10 was shorter than IL-6.The levels of PRE,TRF and RbP were considerably decreased after operation in both groups （P0.01）,but there was no difference at the 1st and 2nd day （P0.05）.All levels of the four proteins in the laparoscopic group were significantly higher than those in the open group at the 3rd day postoperatively （P0.01）.Conclusions：According to the consequence of postoperative stress level and visceral proteins,laparoscopic radical resection of colorectal carcinoma results in less prominent stress response and trauma compared to open surgery in aged patient and it benefits the restoration of visceral proteins,which are strong supports for the minimally invasive surgery.

关 键 词：结直肠肿瘤 腹腔镜检查 应激 内脏蛋白 老年人 

分 类 号：R735.3[医药卫生—肿瘤]