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目的探讨腹腔镜辅助和开腹结直肠癌根治术对机体应激反应的影响。方法选择2年来收治的结直肠癌患者40例。20例行腹腔镜辅助结直肠癌根治术(LAP组);20例行开腹结直肠癌根治术(OP组)。比较两组患者术前及术后第1～3天外周静脉血血糖(BG),胰岛素(Ins),三碘甲状腺原氨酸(T3),四碘甲状腺原氨酸(T4),促甲状腺激素刺激激素(TSH),皮质醇(CS)的变化。结果两组的临床病理资料均具可比性(P>0.05)。两种术式术后第1天BG及CS均升高,至术后第2天LAP组BG及CS恢复至术前水平(P>0.05);OP组至术后第3天恢复至术前水平(P>0.05)。OP组术后第2天BG及CS水平明显高于LAP组(P<0.05)。两种术式术后第1天Ins,T3及T4均降低,LAP组该3指标至术后第2天恢复至术前水平(P>0.05),而OP组至术后第3天恢复至术前水平(P>0.05)。OP组术后第2天Ins,T3及T4水平明显低于LAP组(P<0.05)。LAP组与OP组手术前后TSH无统计学差异(P>0.05)。结论腹腔镜结直肠癌手术与开腹根治术比较,前者机体应激反应持续时间较短,反应强度较轻。
Objective To investigate the effect of laparoscopic-assisted and open radical resection of colorectal cancer on stress response in vivo. Methods Forty patients with colorectal cancer who were treated in 2 years were selected. Twenty patients underwent laparoscopic radical colorectal cancer (LAP group) and 20 underwent radical open radical resection of colorectal cancer (OP group). The levels of blood glucose (BG), insulin, triiodothyronine (T3), tetrathionine (T4), thyrotropin Stimulating hormone (TSH), cortisol (CS) changes. Results The clinical and pathological data of the two groups were comparable (P> 0.05). BG and CS both increased on the first postoperative day in both groups, and the levels of BG and CS in the LAP group recovered to the preoperative levels on the second postoperative day (P> 0.05). The OP group returned to preoperative Level (P> 0.05). The levels of BG and CS in OP group were significantly higher than those in LAP group on the second day after operation (P <0.05). Ins, T3 and T4 decreased on the first postoperative day in both groups. The index of LAP group returned to the preoperative level on the second postoperative day (P> 0.05), while in the OP group, the third day postoperatively recovered to Preoperative level (P> 0.05). The levels of Ins, T3 and T4 on the second postoperative day in OP group were significantly lower than those in LAP group (P <0.05). There was no significant difference in TSH between LAP group and OP group before and after operation (P> 0.05). Conclusion Laparoscopic colorectal surgery and laparotomy compared with the former, the duration of stress response is shorter, the reaction intensity is lighter.