高凝状态相关指标在结直肠癌患者手术前后的变化及术式的影响

目的：探讨结直肠癌患者手术前后高凝状态相关指标的变化，以及不同手术方式对其的影响。方法：74例结直肠癌患者随机分为开腹组、腔镜组，分别行传统开腹手术和腹腔镜手术，并以37例健康查体者作为对照组，检测对照组以及手术前后两组结直肠癌患者血清D-二聚体、纤溶酶原激活物抑制物1（PAI-1）、凝血酶原片段1+2（F1+2）及蛋白C水平。结果：与健康对照者比较，结直肠癌患者的术前D-二聚体、PAI-1、F1+2表达水平明显升高，而蛋白C水平明显降低（均P<0.05）；与术前比较，两组结直肠癌患者术后D-二聚体、蛋白C水平升高，而PAI-1、F1+2水平降低（均P<0.05）；术后腔镜组D-二聚体、蛋白C水平与开腹组差异无统计学意义（均P>0.05），但PAI-1、F1+2水平高于开腹组（均P<0.05）。结论：结肠癌患者血液呈高凝状态，术后情况改善，但腹腔镜手术可能对某些指标产生短暂的不利影响，应予重视。

Pre- and postoperative changes of parameters related to hypercoagulability in colorectal patients and the influence of mode of operation

Objective: To investigate the alterations in parameters related to hypercoagulability in colorectal patients before and after operation, and the influence of different types of operation on these parameters. Methods: Seventy-four patients with colorectal cancer were equally randomized into open surgery group and laparoscopic group, and then underwent conventional open surgery and laparoscopic resection, respectively. Thirty-seven subjects undergoing health maintenance examination served as control group. The serum levels of D-dimer, plasminogen activator inhibitor-1 (PAI-1), prothrombin fragment 1+2 (F1+2) and protein C in control group and the two groups of colorectal cancer patients before and after operation were measured. Results: Compared with healthy controls, the levels of D-dimer, PAI-1 and F1+2 were significantly increased, while the protein C level was significantly decreased in colorectal cancer patients (all P<0.05). In both groups of colorectal cancer patients, the levels of D-dimer and protein C were elevated, and the levels of PAI-1 and F1+2 were reduced compared with those values before operation (all P<0.05). The postoperative levels of D-dimer and protein C showed no statistical difference between laparoscopic group and open surgery group (both P>0.05), but the levels of PAI-1 and F1+2 in laparoscopic group were higher than those in open surgery group (both P<0.05).Conclusion: Colorectal patients have a hypercoagulable state that can improve after surgical resection. However, laparoscopic resection may probably exert a temporary and unfavorable influence on some hypercoagulable parameters, and this should be given due attention.