摘要
目的探讨腹腔镜与开腹直肠癌根治术围手术期C反应蛋白、能量代谢及血清内脏蛋白的差异。方法将45例行直肠癌根治术患者按患者意愿分为腹腔镜组(n=20)和开腹组(n=25),于术前、术后第1天、术后第2天、术后第3天晨检测血C反应蛋白(C-reactiveprotein,CRP)及内脏蛋白:白蛋白(albumin,ALB)、前白蛋白(prealbumin,PRE)、转铁蛋白(transferrin,TRF)、视黄醇结合蛋白(retinal-bindingprotein,RbP)的变化,同时应用间接能量测定仪测定静息能量消耗(restingenergyexpenditure,REE)。结果两组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)。两组术后1、2、3dREE亦较术前明显升高(P<0.05,P<0.01),术后1、3d腹腔镜组明显低于开腹组(P<0.05)。ALB、PRE、TRF、RbP两组术后均较术前有明显下降(P<0.01)。术后1d两组各指标差异无显著性(P>0.05);术后2d腹腔镜组PRE明显高于开腹组(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)。结论腹腔镜直肠癌根治术较开腹手术创伤小,应激水平低,有利于机体能量代谢及内脏蛋白的恢复,但其同传统开腹手术均可导致术后早期机体营养不良状态的发生。
Objective To compare the differences between laparoscopic-assisted and open resection of rectal carcinoma in respect of peri-operative levels of C - reactive protein （ CRP）, rest energy expenditure （ REE）, and visceral proteins. Methods According to patients＇choice of operation, either laparoseopie-assisted （ n = 20, Laparoseopie Group） or open （ n = 25, Open Group） resection of rectal carcinoma was performed. The levels of CRP and visceral proteins - including albumin （ ALB）, prealbumin （ PRE）, transferrin （TRF） , and retinal-binding protein （RbP） - were assayed preoperatively and on the 1 st, 2nd, and 3rd day postoperatively. The levels of REE were also measured by indirect calorimetry in the morning. Results Compared with the preoperative period, the CRP levels in both groups were significantly increased on the 1st, 2nd, and 3rd day （P 〈 0.01 ） and peaked on the 2nd day postoperatively. The postoperative CRP levels were significantly lower in the Laparoseopie Group than in the Open Group （ P 〈 0.01 ）. After operation, the REE levels were significantly increased in both groups （P 〈 0.05, P 〈 0. 01 ）, with the responses in the Laparoseopie Group significantly lower than those in the Open Group on the 1st and 3rd day postoperatively （P 〈0. 05）. The levels of ALB, PRE, TRF, and RbP were significantly decreased after operation in both groups （P 〈 0. 01 ）. There was no significant difference between the two groups in levels of ALB, PRE, TRF, and RbP on the 1st postoperative day （ P 〉 0.05 ）. The levels of PRE in the Laparoseopie Group were significantly higher than those in the Open Group on the 2nd postoperative day （ P 〈 0.05 ） , and the levels of the four proteins in the Laparoseopie Group were significantly higher than those in the Open Group on the 3rd postoperative day （P 〈 0. 01 ）. Conclusions Laparoseopie-assisted resection of rectal carcinoma gives lower levels of stress responses compared to open surgery, which benefits the restoration of energy metabolism and visceral proteins. However, both laparoseopie and open operation can result in malnutrition at early period postoperatively.
出处
《中国微创外科杂志》
CSCD
2007年第1期57-60,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
结直肠肿瘤
外科学
能量代谢
内脏蛋白
营养状态
Laparoseopy
Coloreetal neoplasm
Surgery
Energy metabolism
Visceral protein
Nutritional status
