腹腔镜结直肠癌手术对腹膜微结构损伤和纤维溶解分子表达的影响  

Impact of laparoscopic colorectal surgery on the peritoneal microstructural injury and expressionof t-PA/PAI-1

作　　者：张瑞[1] 武书胜[1] 陈智[1] 徐钧[1] 底卫东[1] 董博[1] 张宇红[1] 赵保玉[1] 

机构地区：[1]山西省人民医院普通外科,太原030012

出　　处：《中华胃肠外科杂志》2012年第8期837-840,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨腹腔镜结直肠癌根治术对腹膜微结构损伤和腹膜纤维溶解分子表达的影响。方法前瞻性纳入2011年6月至2012年2月问山西省人民医院收治的50例结直肠癌患者．根据患者意愿和医生决策分为腹腔镜组（27例）和开腹组（23例）。分别在光镜和电镜下观察术后腹膜微结构损伤程度：采用ELISA法比较手术前后腹膜组织型纤溶酶原激活物t-PA和纤溶酶原激活物抑制因子1（PAI-1）水平的改变。结果术后标本光镜和电镜观察显示，开腹组肠管浆膜完整性受损、系膜脂肪细胞与间皮细胞覆盖脱失、炎性细胞聚集程度较腹腔镜组严重，两组损伤评分比较的总平均秩次分别为38．22和14．67，差异有统计学意义（P〈0．01）。术后网膜组织t-PA、肠管浆膜组织t-PA及PAI-1水平的差异均无统计学意义（均P〉0．05）；但腹腔镜组网膜组织中PAI-1水平显著低于开腹组（P〈0．05）。结论相对于开腹手术，腹腔镜结直肠癌根治术腹膜损伤程度较轻，对腹膜纤溶功能的影响较小．有利于防止肠粘连的形成。Objective To assess the influence of laparoscopic colorectal cancer resection on the peritoneal microstructure injury and expression of t-PA/PAI-1 molecules. Methods A total of 50 patients with colorectal cancer were prospectively enrolled between June 2011 and February 2012 in the Shanxi Provincial Hospital and were assigned into laparoscopic group （LO, n=27） and conventional laparotomy group （CO, n=23） based on patients expectancy and surgeon decision. Optical microscope and scanning electron microscope were employed for comparison of the postoperative peritoneal injury between LO and CO. Before and after surgery, t-PA and PAI-1 of peritoneal tissue were determined by ELISA in both groups. Results Optical microscope and scanning electronic microscopy scan indicated less serosal injury in LO group than that in CO group with regard to serosa integrity, continuity of covering adipocytes and mesothelial cells, and the aggregation level of inflammatory cells（P〈0.01 ）. The injury score was 38.22 in CO in and 14.67 in LO and the difference was statistically significant （P〈 0.01）. No significant differences were found between LO and CO in terms of postoperative t-PA in the omentum, t-PA and PAI-1 in the intestinal serosa tissue（P〉0.05）, however PAI-1 in the omentum was significantly lower in LO group compared to CO group （P〈0.05）. Conclusion Laparoscopic radical resection for colorectal cancer causes less peritoneal structural injury and less influence on the fibrinolytic capacity, which may contribute to less postoperative adhesion.

关 键 词：结直肠肿瘤 腹腔镜 腹膜损伤 组织型纤溶酶原激活物 纤溶酶原激活 物抑制因子 

分 类 号：R735.3[医药卫生—肿瘤]