摘要
目的：研究腹腔镜下保留盆腔自主神经直肠癌根治术对冲洗液及血清中黏附分子、术后脏器功能的影响。方法：选择2013年5月~2015年12月在本院接受全腹腔镜下直肠系膜切除术的86例直肠癌患者进行回顾性分析,37例患者在术中保留盆腔自主神经、纳入A组,49例患者在术中未保留盆腔自主神经、纳入B组。术后当天,测定血清肿瘤标志物、黏附分子的含量以及腹腔冲洗液中黏附分子的含量;术后1个月时,评估尿流动力学指标。结果：术后当天,A组患者血清中癌胚抗原（CEA）、糖类抗原199（CA199）、糖类抗原125（CA125）、糖类抗原724（CA724）、细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）、CD44v6、骨桥蛋白（OPN）的含量以及腹腔冲洗液中ICAM-1、VCAM-1、CD44v6、OPN的含量均显著低于B组,血清和腹腔冲洗液中E-钙黏蛋白（E-cadherin）的含量显著高于B组;术后1个月时,A组患者最大尿流率（QMax）、最大膀胱逼尿肌收缩压（PdetMax）、排尿量均显著高于B组,残余尿量显著低于B组。结论：腹腔镜下直肠癌根治术中保留盆腔自主神经能够减少黏附分子的释放、降低术后排尿功能障碍的发生风险,具有积极的临床应用价值。
Objective： To study the effect of pelvic autonomic nerve preservation in laparoscopic radical resection of rec- tal carcinoma on adhesion molecules in washing fluid and serum as well as postoperative organ function. Methods： 86 patients with rectal carcinoma who received laparoscopic total mesorectal excision in our hospital between May 2013 and December 2015 were retrospectively analyzed, 37 patients were with intraoperative pelvic autonomic nerve preservation and included in group A, and 49 patients were without intraoperative pelvic autonomic nerve preservation and included in group B. The same day after operation, the levels of tumor markers and adhesion molecules in serum as well as the levels of adhesion molecules in peritoneal washing liquid were determined; one month after operation, urodynamies indexes were assessed. Results： The same day after operation, CEA, CA199, CA125, CA724, ICAM-1, VCAM-1, CD44v6 and OPN content in serum as well as ICAM-1, VCAM-1, CD44v6 and OPN content in peritoneal washing liquid of group A were significantly lower than those of group B while E-cadherin content in serum and peritoneal washing liquid were significantly higher than those of group B~ one month af- ter operation, QMax, PdetMax and urine output of group A were significantly higher than those of group B while residual urine volume was significantly lower than that of group B. Conclusions： Pelvic autonomic nerve preservation in laparoscopic radical resection of rectal carcinoma can decrease the release of adhesion molecules and reduce the risk of postoperative urination dys- function, and it has positive clinical application value.
出处
《海南医学院学报》
CAS
2016年第22期2755-2758,共4页
Journal of Hainan Medical University
基金
江苏省卫生厅课题(2015102015)
Financially Supported by Special Foundation for Clinical Studies from Committee of Medical Journal of Chinese Universities(11221022)
关键词
直肠癌
腹腔镜
盆腔自主神经
黏附分子
尿流动力学
Rectal carcinoma
laparoscope
pelvic autonomic nerves adhesion molecule
urodynamics
