腹腔镜结直肠癌手术对机体生理应激反应的研究

目的探讨腹腔镜结直肠癌手术与传统开腹手术对围手术期机体生理应激变化的影响。方法选择2008年5月至2010年8月收治的结直肠癌患者86例,分为腔镜组40例,开腹组46例。比较两组围手术期皮质醇、白细胞、血糖、血小板变化。结果两组患者术前各指标检测值比较无统计学意义。两组术后皮质醇明显升高(P0.05),术后3d开腹组升高明显大于腔镜组(P0.05),术后8d两组均恢复到术前水平;两组白细胞较术前明显升高,术后1d开腹组比同期腔镜组升高明显(P0.05),随后两组逐渐恢复到术前水平。两组术后血糖均明显高于术前水平(P0.05),随后逐渐下降,术后1d腔镜组升高小于开腹组有统计学意义(P0.05)。两组术后1d血小板明显降低,术后8d两组均恢复到术前,且同时期腔镜组升高明显快于开腹组(P0.05)。结论腹腔镜结直肠癌手术对机体术后应激反应轻于传统开腹手术。

The Study of Physiological Responses of Laparoscopic Surgery For Colorectal Cancer

Objective To investigate the changes of physiological function of the patients undergoing lapa-roscopy assisted colorectal cancer surgery during perioperation period. Methods Eighty-six patients with colorectal cancer undergoing elective surgery were assigned to laparoscopy assisted group （N = 40） and conventional open abdominal group （ N= 46）. Comparison of perioperative blood glucose, cortisol, white blood cells （WBC）, platelets and other changes were conducted. Results The testing value of each index was no statistical significance before surgery. Postoperative cortisol levels were significantly higher than pre-operation （ P 〈0.05 ）. The open abdominal group was significantly greater than the laparoscopically assisted group （ P 〈0.05 ）. The level of cortisol in the two groups returned to preoperative levels at the 8th day after peration. The blood WBC of the two groups was significantly higher compared with the preoperation. The level of blood WBC in the open abdominal group was significantly higher than laparoscopy assisted group in the first postoperative day （ P 〈0.05）, followed by the two groups gradually returned to preoperative levels. The level of postoperative blood glucose were significantly higher than pre-operation （ P 〈0.05）, then decreased gradually after ld of which endoscopic group was significantly less than the laparotomy group （ P 〈0.05）. Compared with the preoperative level of PLT, the postoperative decreased significantly in both groups （ P 〈0.05）. The two groups returned to preoperative levels at postoperative 8th day, and the laparoscopy assisted group was significantly higher than the same period in open abdominal group （ P 〈0.05）. Conclusion Laparoscopic surgery for colorectal cancer on the body＇s physiological inhibition were more lighter than conventional open surgery. Compared to conventional open surgery, laparoscopic surgery for colorectal cancer has greater advantages on the physiological responses.