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目的:通过观察腹腔镜和开腹直肠癌手术术后胃饥饿素的动态变化,探讨胃饥饿素在术后应激反应期的临床意义。方法:选取2013年3月—2014年3月在行直肠癌手术的患者50例,按照随机数字表法分为开腹手术组(开腹组)和腹腔镜手术组(腔镜组)各25例,记录两组的手术指标(手术时间、术中出血量、术后排气时间、住院天数),监测术前及术后6、12、24、36、48、72 h 7个时间节点的血清胃饥饿素、TNF-α、IL-6、IL-8及CRP水平。采用Pearson相关分析检验胃饥饿素与炎性细胞因子的关系。结果:两组患者的手术指标比较差异均有统计学意义(P<0.05);术后两组患者的血清胃饥饿素和TNF-α、IL-6、IL-8、CRP水平升高,并于术后24 h达到峰值,开腹组明显高于腔镜组,差异具有统计学意义(t=2.837、2.904、2.671、2.802,均P<0.05);术后36 h两组患者的血清胃饥饿素水平开始下降,术后72 h恢复至术前水平。经Pearson相关系数分析术后24 h血清胃饥饿素水平与CRP、TNF-α、IL-6、IL-8均存在线性关系,呈正相关性(r=0.65、0.55、0.63、0.70,均P<0.05)。结论:直肠癌术后应激反应期的炎性反应会导致患者外周血中胃饥饿素的水平升高,其升高程度与手术损伤程度有关,与炎性反应程度呈正相关,可能与胃饥饿素剂量依赖性抑制炎性反应保护机体的机制有关。
Objective: To investigate the clinical significance of ghrelin in postoperative stress response by observing the dynamic changes of ghrelin after laparoscopic and open rectal cancer surgery. Methods: Fifty patients undergoing rectal cancer surgery from March 2013 to March 2014 were selected and divided into two groups according to the random number table: laparotomy group (laparotomy group) and laparoscopic surgery group (laparoscopic group) For example, the operation indexes (operation time, intraoperative blood loss, postoperative exhaust time, hospitalization days) of both groups were recorded, and the time points before, at 6, 12, 24, 36, 48, Serum ghrelin, TNF-α, IL-6, IL-8 and CRP levels were measured. Pearson correlation analysis was used to examine the relationship between ghrelin and inflammatory cytokines. Results: There were significant differences in the surgical parameters between the two groups (P <0.05). The levels of ghrelin, TNF-α, IL-6, IL-8 and CRP in the two groups were significantly increased Peaked at 24 h after operation, and significantly higher in laparotomy group than in laparoscopic group (t = 2.837,2.904,2.671,2.802, both P <0.05) Ghrelin levels began to decline, 72 h after surgery returned to preoperative levels. There was a positive correlation between serum ghrelin and CRP, TNF-α, IL-6 and IL-8 at 24 h after Pearson correlation coefficient analysis (r = 0.65,0.55,0.63,0.70, P < 0.05). Conclusion: The postoperative inflammatory reaction of rectal cancer will lead to elevated levels of ghrelin in peripheral blood of patients with rectal cancer, the degree of which is related to the degree of surgical injury, and is positively correlated with the degree of inflammatory reaction, which may be related to gastric starvation A dose-dependent inhibition of the inflammatory response to protect the body’s mechanisms.