【作者】 邱志刚；

【导师】 张建立；

【作者基本信息】 青岛大学 ， 普外科， 2007， 硕士

【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-reactive protein，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-binding protein，RbP)的变化，同时应用间接能量测定仪测定静息能量消耗(Resting energy expenditure，REE)。结果两组CRP在术后1、2、3 d均较术前明显升高(P＜0.01)，术后2 d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、3 d REE亦较术前明显升高(P＜0.05，P＜0.01)，术后1、3 d腹腔镜组明显低于开腹组(P＜0.05)。ALB、PRE、TRF、RbP指标在两组术后均较术前有明显下降(P＜0.01)。术后1 d两组各指标无显著性差异(P＞0.05)；术后2 d腹腔镜组PRE明显高于开腹组(P＜0.05)；术后3 d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，对机体能量代谢影响小，有利于机体能量代谢及血清内脏蛋白的恢复，但其同传统开腹手术均可导致术后早期血清内脏蛋白水平的显著下降。更多还原

【Abstract】 Objective To compare the differences between laparoscopic-assisted and openresection 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, ether laparoscopic-assisted (n=20, Laparoscopic Group) or open (n=25, Open Group) resection of rectal carcinomawas performed. The levels of CRP and visceral proteins - including albumin(ALB),prealbumin(PRE), transferrin(TRF) and retinal-binding protein(RBP) - were assayedpreoperatively and on the 1st, 2nd and 3rd day postoperatively. The levels of REE werealso measured by indirect calorimetry in the morning.Results Compared to the preoperative period, the CRP levels in both groups wereincreased significantly on the 1st, 2nd and 3rd day (P＜0.01) and peaked on the 2nd daypostoperatively. The postoperative CRP levels were significantly lower in theLaparoscopic Group than in the Open Group (P＜0.01). After operation, the REE levelswere significantly increased in both groups (P＜0.05, P＜0.01), with the responses in theLaparoscopic Group significantly lower than those in the Open Group on the 1st and 3rdday postoperatively (P＜0.05). The levels of ALB, PRE, TRF and RbP were significantlydecreased after operation in both groups (P＜0.01). There was no significant differencebetween the two groups in levels of ALB, PRE, TRF and RbP on the 1st postoperativeday (P＞0.05). The levels of PRE in the Laparoscopic group were significantly higher thanthose in the Open Group on the 2nd postoperative day (P＜0.05), and the levels of the fourproteins in the Laparoscopic Group were significantly higher than those in the OpenGroup on the 3rd postoperative day (P＜0.01).Conclusions Laparoscopic-assisted resection of rectal carcinoma gives lower levelsof stress responses compared to open surgery, which benefits the restoration of energymetabolism and visceral proteins. However, both the laparoscopic and open operation can result in significant decrease in visceral proteins at early period postoperatively.更多还原