腹腔镜与开腹直肠癌根治术对老年患者机体炎症影响的比较(1)
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[摘要] 目的:比较腹腔镜与开腹直肠癌根治术对老年患者机体炎症的影响。方法:选择行腹腔镜直肠癌根治术的老年患者40例设为腹腔镜组,选择同期行开腹直肠癌根治术的老年患者40例设为开腹组。比较两组患者的围术期情况、手术前后炎症因子水平和并发症发生情况。结果:腹腔镜组患者的手术时间、术中失血量、肠道排气时间和住院时间均明显少于开腹组(P<0.01);腹腔镜组患者术后1、3 d的血清CRP和IL-6等炎症因子水平明显低于开腹组,而TNF-α水平明显高于开腹组,两组比较,差异均有统计学意义(P<0.01或P<0.05);腹腔镜组患者术后并发症发生率明显低于开腹组(P<0.05)。结论:相对开腹直肠癌根治术而言,腹腔镜直肠癌根治术对老年患者组织损伤较小,炎症反应更弱,术后恢复更快。
[关键词] 腹腔镜;直肠癌;炎症;对比研究
[中图分类号] R574.63[文献标识码]A [文章编号]1673-7210(2010)05(b)-033-03
Effect of laparoscopic and open radical resection of rectal carcinoma on inflammatory cytokines in elderly patients
ZHANG Jinhui
(The First People's Hospital in Baiyun District of Guangzhou City, Guangzhou 510410, China)
[Abstract] Objective: To investigate the impact of laparoscopic and open radical resection of rectal carcinoma on inflammatory cytokines in elderly patients. Methods: 40 cases of elderly patients with rectal carcinoma scheduled for laparoscopy acted as laparoscopic group, and another 40 cases referred to open surgery as open group. A comparison was undertaken in terms of the perioperative status, pre- and post-operative levels of the inflammatory cytokines and complication incidence. Results: The duration of surgery, intra-operative blood loss, time for anal exsufflation and hospital stay were markedly less in the laparoscopic group than in the control group (all P<0.01); the serum levels of CRP and IL-6 1 and 3 days after surgery were considerably lower in the laparoscopic group than those in the control group, while the level of TNF-alpha was increased, with significant differences between two groups (P<0.01 or P<0.05); and the incidence rate for complication was much lower (P<0.05). Conclusion: Compared with open surgery, the laparoscopic-assisted radical resection of rectal carcinoma may have less tissue injury, weaker inflammatory reaction and more rapidly postoperative recovery.
[Key words] Laparoscopy; Rectal carcinoma; Inflammation; Comparative study
直肠癌是消化道最常见的恶性肿瘤之一,严重危害人类健康。手术切除仍是治疗直肠癌的主要方法,其中,腹腔镜直肠癌根治术具有美容效果好、术后胃肠道功能恢复快、住院时间短及对术后生活质量影响小等优点,已获广泛认可[1]。然而就老年患者而言,腹腔镜技术是否适用仍有争议[2],而且目前国内外有关腹腔镜与开腹直肠癌根治术对机体炎症影响的研究较少,且存在争议[3-4]。本文中笔者通过比较腹腔镜与开腹直肠癌根治术前后血清C-反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)等炎症因子水平的变化以及围术期状况和并发症发生的差异,旨在进一步探讨两种术式对老年患者机体炎症的影响,从临床以及病理生理基础方面为老年患者行腹腔镜直肠癌根治术的可行性、安全性及优越性提供参考依据。 ......
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