摘要
目的探讨快速康复外科(fast track surgery,FTS)对腹腔镜结直肠癌手术患者胰岛素抵抗(insulin resistance,IR)和炎性应激反应的影响。方法将2013年2月~2015年6月62例腹腔镜结直肠癌手术患者按随机数字表法分为FTS组和非FTS组,各31例,比较2组患者术后肛门排便、排气时间,术后住院时间,住院总费用和手术并发症。术前(T_0),术后第1、3、7天(T_1、T_3、T_7)4个时点检测2组胰岛素抵抗及炎性反应指标,包括空腹血糖(fasting blood-glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)和肿瘤坏死因子(tumor necrosis factor,TNF-α),采用稳态模式评估法(homeostasis model assessment,HOMA)计算胰岛素抵抗指数(HOMA-IR)。结果 FTS组患者术后肛门首次排气时间、排便时间显著短于非FTS组(t=3.088,P=0.003;t=4.227,P=0.000),术后住院时间、住院总费用显著低于非FTS组(t=3.937,P=0.000;t=3.478,P=0.003),2组并发症发生率无统计学差异(χ~2=0.267,P=0.605)。2组患者T_1、T_3时点上述炎性指标和IR指标均较T0时点明显升高(P均<0.05);在T_1、T_3时点,与FTS组比较,非FTS组IL-6、CRP、TNF-α、FINS和HOMA-IR升高更明显(P<0.05),血FBG升高不明显(T_1:t=0.870,P=0.388;T_3:t=0.870,P=0.388)。2组患者T_7时点IL-6和TNF-α基本恢复到T0时点水平(P均>0.05),CRP、FBG、FINS和HOMA-IR值仍高于T_0水平(P均<0.05);FTS组患者T_7时点血IL-6、TNF-α、FBG、FINS和HOMA-IR值与非FTS组比较无统计学差异(P>0.05),血CRP明显低于非FTS组(t=-4.527,P=0.000)。结论 FTS用于腹腔镜结直肠癌手术可促进患者早期胃肠道功能恢复,减轻应激反应,降低术后IR,有效加速术后康复。
Objective To investigate the influence of fast track surgery （FTS） on insulin resistance indexes and inflammatory reaction in colorectal cancer patients who received laparoscopic surgery. Methods A total of 62 patients were randomly divided into control group （n = 31 ） or FTS group （ n = 31 ）. The postoperative first flatus and defecation time, postoperative hospital stay, hospitalization expenditure, and postoperative complications were recorded. Insulin resistance indexes and inflammatory reaction were measured before operation （T0） as well as on the 1st, 3rd, and 7th postoperative days （T1, T3, and T7 ） , including fasting blood- glucose （FBG） , fasting insulin （FINS） , serum level of interleukin-6 （IL-6） , C-reactive protein （CRP） , and tumor necrosis factor （TNF-（x）. The insulin resistance index （HOMA-IR） was calculated at the same time points. Results The postoperative time of flatus and defecation in the FTS group was significantly shorter than that in the control group （t =3. 088, P =0. 003; t =4. 227, P = 0. 000） , the postoperative hospital stay and total hospitalization expenditure were significantly lower in FTS group （ t = 3. 937, P = 0. 000; t = 3. 478, P = 0. 003 ）. No significant difference was found in the complication rate between the two groups （X2 = 0. 267,P = O. 605 ）. The inflammatory indexes and insulin resistance indexes in the two groups at Tl and T3 time points were higher than those at To time points （P 〈 0.05）. Compared to the FTS group at T~ and T3 time points, the levels of IL-6, CRP, TNF-α, FINS, and HOMA-IR in the control group increased more obviously （P 〈 O. 05） , but the elevation blood FBG was not obvious （TI ： t = O. 870, P = 0. 388 ; T3 ： t = 0. 870, P = 0. 388）. There were no significant differences in IL-6 and TNF-α in the two groups between the T7 and To time points （P 〉 0. 05） , but the levels of CRP, FBG, FINS, and HOMA-IR at T7 time points were significantly higher than those at the To time points in the two groups （P 〈 0.05）. The levels of IL-6, TNF-α, FBG, FINS, and HOMA-IR at T7 had no significant differences between the two groups （ P 〉 0.05 ） , but the level of CRP in the control group was significantly higher than that in the FTS group （t = -4. 527, P = 0. 000）. Conclusion FTS may promote the early recovery of gastrointestinal functions, reduce stress reactions and postoperative insulin levels, thus being conducive to fast rehabilitation in eolorectal cancer patients with laparoseopic surgery.
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第5期450-454,共5页
Chinese Journal of Minimally Invasive Surgery
基金
南京市科研发展项目(项目编号:YKK12220)
关键词
结直肠肿瘤
快速康复外科
腹腔镜
胰岛素抵抗
Colorectal neoplasms
Fast track surgery
Laparoscope
Insulin resistance
