高龄患者腹腔镜结直肠癌根治术围手术期对机体应激及内脏蛋白的影响

目的:研究高龄病人(75岁以上)腹腔镜与开腹结直肠癌根治术围手术期白介素6(IL-6)、IL-10和C反应蛋白(CRP)及内脏蛋白的差异.方法:将41例行结直肠癌根治术的高龄患者按患者意愿分为腹腔镜组(n=20)和开腹组(n=21),两组患者的一般资料如年龄、性别、体重指数(BMI)等有可比性,检测两组患者术前、术后的应激指标:血清IL-6、IL-10和CRP及营养蛋白:前白蛋白(prealbumin,PRE)、转铁蛋白(transferrin,TRF)、视黄醇结合蛋(retinal-binding protein,RbP)的变化.结果:两组患者CRP在术后1、2、3d均较术前明显升高(P<0.01),术后2d达到峰值,腹腔镜组术后CRP明显低于开腹组(P<0.01);两组患者血清IL-6、IL-10术后也明显升高,腹腔镜组明显低于开腹组(P<0.01),但IL-10升高持续时间短.PRE、TRF、RbP术后两组均较术前有明显下降(P<0.01),术后1 d、2 d两组各指标无显著性差异(P>0.05),术后3 d腹腔镜组4种蛋白指标均明显高于开腹组(P<0.01).结论:对高龄病人两种不同手术方式应激水平及内脏蛋白指标的研究提示,腹腔镜结直肠癌根治术较开腹手术创伤小,应激水平低,有利于机体内脏蛋白的恢复,这对微创外科的实施是一个有力支持.

Impact of elderly patient laparoscope colorectal cancer radical operation for body stress and visceral protein

Objective: To compare the alterations of operative stress response-reactive protein(CRP),interleukin-6(IL-6),IL-10and visceral proteins after laparoscopic-assisted and open resection of colorectal carcinoma in advanced age patients.Methods: According to the patients' choice of the operation,laparoscopic-assisted(n=20)and open(n=21)resection of eoloreetal carcinoma were performed.IL-6,IL-10,CRP and visceral protein which includes Prealbumin(PRE),Transferrin(TRF)and Retinal-binding protein(RBP)were as-sayed preoperatively and at the 6h,1st,2nd and 3rd day postoperatively.Results: CRP levels in both groups increased at the 1st,2nd and 3rd day postoperatively compared to the preoperative period(P<0.01)and peaked at the 2nd day postoperatively,the responses in the la-paroscopic group significantly less than those in the open group(P<0.01).The plasma levels of IL-6 and IL-10 were significantly in-creased after the operation in both groups,which was significantly lower in the laparoscopic group.The levels of PRE,TRF and RbP significantly decreased after operation in both groups(P<0.01),but there are not differences at the 1st and 2nd day(P>0.05),all the levels of the four proteins in the laparoscopie group were significantly higher than those in the open group at the 3rd day postoperatively(P<0.01).Conclusions: Laparoscopic-assisted resection of eoloreetal carcinoma results in less prominent stress response compared to open surgery in advanced age patient,These benefit the restoration of visceral proteins.It's a strong support for the practice of minimal invasive surgery.