开腹与腹腔镜直肠癌根治术后炎性反应的比较  

Comparison of Inflammatory Response after Laparotomy and Laparoscopic Radical Resection for Rectal Carcinoma

作　　者：郭灿[1] 向江琳[2] 邹中辉[1] 章伟[1] 郭宁[1] 

机构地区：[1]重庆三峡中心医院普外二科,重庆404000 [2]重庆三峡中心医院感染科,重庆404000

出　　处：《南昌大学学报（医学版）》2014年第11期48-51,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的比较开腹与腹腔镜直肠癌根治术后患者全身和腹腔炎性反应的差异。方法 2012年1月至2013年12月共治疗78例直肠癌患者,其中腹腔镜手术46例,开腹手术32例,比较2组的手术及炎性反应指标。结果2组患者的手术时间、术中出血量及术后第1天引流量比较差异无统计学意义(P>0.05)。开腹组的切口长度、排气时间、住院时间、术后第4天引流量及并发症均长于或高于对照组,差异有统计学意义(P<0.05)。2组患者术前血液中各项炎性反应指标比较差异均无统计学意义(P>0.05),术后第1天及第4天较术前均升高(P<0.05)。术后第1天腹腔镜组血液中各个炎性反应指标均低于开腹组,差异有统计学意义(P<0.05);术后第4天腹腔镜组血液中各个炎性反应指标均低于开腹组,但差异无统计学意义(P>0.05)。术后第1天及第4天腹腔镜组腹腔引流物中各个炎性反应指标均低于开腹组,但是只有术后第4天的腹腔引流物CRP、IL-6、IL-10及TNF-α浓度比较差异具有统计学意义(P<0.05)。结论腹腔镜直肠癌根治术患者术后早期的腹腔炎性反应与开腹手术相当,但是全身炎性反应比开腹手术轻。Objective To compare the systemic and abdominal inflammatory response after laparotomy and laparoscopic radical resection for rectal carcinoma.Methods The operation and inflammatory response indexes were compared between patients who underwent laparoscopic surgery（n=46）and patients who underwent laparotomy（n=32）for rectal carcinoma between January 2012 and December 2013.Results There were no differences in operative time,intraoperative blood loss and drainage volume on the first postoperative day between the two groups（P〉0.05）.Compared with laparoscopic surgery group,the length of incision,time to first flatus,hospital stay and drainage volume on postoperative day 4obviously increased in laparotomy group（P〈0.05）.No significant differences in serum levels of inflammatory makers were found between the two groups before operation（P〉0.05）.Compared with preoperative levels,serum inflammatory makers significantly increased on postoperative days 1and 4（P〈0.05）.In addition,serum levels of inflammatory makers in laparoscopic surgery group were lower than those in laparotomy group on postoperative days 1and 4（P〈0.05 and P〉0.05,respectively）.The levels of inflammatory makers in the drainage in laparoscopic surgery group were lower than those in laparotomy group on postoperative days 1and 4.However,only the differences in C-reaction protein,interleukin-6,interleukin-10 and tumor necrosis factor-αon postoperative day 4were significant between the two groups（P〈0.05）.Conclusion In the early period after operation for rectal carcinoma,abdominal inflammatory response caused by laparoscopic surgery is similar to that caused by open surgery.However,the systemic inflammatory response caused by laparoscopic surgery is slighter than that caused by open surgery.

关 键 词：直肠癌 腹腔镜 炎性反应 

分 类 号：R735.37[医药卫生—肿瘤]