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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)、视黄醇结合蛋白(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1d、2d两组各指标无显著性差异(P>0.05),术后3d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。
Objective: To study the differences of perioperative IL-6, IL-10 and C-reactive protein (CRP) and visceral proteins in elderly patients (over 75 years old) undergoing laparoscopic and open radical resection of colorectal cancer. Methods: According to the wishes of patients, 41 elderly patients undergoing radical resection of colorectal cancer were divided into laparoscopic group (n = 20) and open group (n = 21). General information such as age, gender, body mass index (BMI) and so on. The indexes of preoperative and postoperative stress in both groups were detected: serum IL-6, IL-10 and CRP and nutrition proteins prealbumin (PRE), transferrin , TRF), retinal-binding protein (RbP). Results: The CRP in both groups was significantly higher than that before operation (P <0.01), and reached the peak at 2 days after operation. CRP in laparoscopic group was significantly lower than that in open group (P <0.01) The levels of serum IL-6 and IL-10 in both groups were significantly higher than those in the laparotomy group (P <0.01), but the duration of IL-10 was short. The levels of PRE, TRF and RbP in both groups were significantly lower than those before operation (P <0.01). There was no significant difference between the two groups on the 1st and 2nd postoperative day (P> 0.05) Indicators were significantly higher than the open group (P <0.01). Conclusion: The study of stress level and visceral protein index in two different surgical methods in elderly patients suggest that laparoscopic radical resection of colorectal cancer is less invasive and less stressful than laparotomy, which is beneficial to the recovery of organ protein The implementation of minimally invasive surgery is a strong support.