腹腔镜结直肠癌手术对应激细胞因子 ET、IL-6及CRP的影响

目的:探讨腹腔镜结直肠癌手术对机体应激反应的影响。方法:选择2006年6月~2007年3月结直肠癌患者35例,分为腹腔镜组15例,开腹组20例。比较两组围手术期内皮素(ET)、白细胞介素-6(IL-6)、C-反应蛋白质(CRP)及相关临床指标的变化。结果:两组患者的性别、年龄、身高、体重、术后病理分期及手术方式差异无统计学意义(P>0.05),平均手术时间腹腔镜组长于开腹组(P<0.05);术中平均出血量开腹组多于腹腔镜组(P<0.05)。腹腔镜组术后第1天ET显著下降(P<0.05),术后第3天恢复至术前水平;开腹组手术前后ET无显著变化。两组术后未出现显著差异。两组患者术后IL-6和CRP均明显升高(P<0.01),且开腹组明显高于腹腔镜组(P<0.01),术后第5天腹腔镜组IL-6恢复至术前水平,但开腹组仍明显高于腹腔镜组(P<0.05)。术后第5天两组CRP仍显著高于术前水平(P<0.05;P<0.01),且开腹组高于腹腔镜组(P<0.05)。结论:腹腔镜结直肠癌手术对ET、IL-6和CRP的影响小,应激反应比开腹手术轻、强度低、持续时间短。

Effect of laparoscopic resection applied to patients with colorectal cancer on ET,IL-6 and CRP

Objective:To investigate the effect of laporoscopic resection applied to patients with colorectal cancer on systemic stress responses.Methods:Thirty-five patients suffering colorectal cancer from Jun.2006 to Mar.2007 were selected.Fifteen of them accepted laparoscopic colectomy(laparoscopic group) and twenty accepted laparocolectomy(laparotomy group).Blood(ET),endotheciuainter interleukin-6(IL-6),C-reactive protein(CRP) levels and general clinical data in peri-operation stage were compared between the two groups.Results:There was no statistical difference between the two groups in sex,age,height,weight,pathological stage of tumor and surgical procedure(P>0.05).The time of laparoscopic operation was significantly longer than laparotomy(P<0.05).The volume of blood loss during laparotomy was larger than laparoscopic operation(P<0.05).The blood ET level of patients in laparoscopic group decreased significantly on the 1st day after operation(P<0.05),and resumed to pre-operation level on the 3rd day after operation,which remained normal in laparotomy group,and there was no statistical difference between the two groups after operation.The blood IL-6 and CRP levels of patients in both groups increased significantly(P<0.01),and it was higher in laparotomy group than in laparoscopic group.The blood IL-6 level resumed to pre-operation on the 5th day after operation,it was still higher in laparotomy group than in laparoscopic group(P<0.05).The blood CRP level of patients in both groups on the 5th day after operation was still higher than that before operation(P<0.05;P<0.01),and it was higher in laparotomy group than in laparoscopic group(P<0.05).Conclusions:Laparoscopic colectomy brought less effect to blood ET,IL-6 and CRP levels,and less effect to systemic stress response intensity and time than laparotomy.