腹腔镜直肠癌Miles手术对血管内皮细胞的影响及术后纤维蛋白溶解的变化

摘要

目的 探讨腹腔镜与传统开腹直肠癌Miles手术对血管内皮细胞的影响及术后纤维蛋白溶解的变化.方法 将60例直肠癌Miles手术按患者意愿分为开腹组(open resection,OR)和腹腔镜组(laparoscopic resection,LR),每组30例,分别于术前24 h、术后0 h、术后24 h检测血内皮素1(endothelial-1,ET-1)、血管性血友病因子(von Willebrand factor,vWF)、血栓调节蛋白(thrombomodulin,TM)、P选择素(P-selectin,PS)、D-二聚体(D-dimer,D-D).结果 OR组与LR组术后0 h血浆ET-1、vWF、TM水平较术前明显升高(P＜0.05),LR组升高幅度明显高于OR组(P＜0.05),术后24 h两组间ET-1、vWF、TM水平无明显差异(P＞0.05),但均高于术前水平(P＜0.05).两组术后0 h血浆D-D、PS水平较术前明显升高(P＜0.05),组间无明显差异(P＞0.05),术后24 h两组D-D、PS水平均继续升高,OR组升高幅度高于LR组(P＜0.01).结论 腹腔镜直肠癌Miles手术会对血管内皮细胞产生更严重的损伤,但这种损伤存在时间短暂.PS及D-D的变化趋势提示开腹手术后形成深静脉血栓的危险性更高.%Objective To compare the influence of laparoscopic and traditional open Miles operation for rectal carcinoma on the vascular endothelial cells and postoperative change of fibrinolysis. Methods Based on the patients' willingness, 60 patients with rectal carcinoma were divided into open resection (OR) group and laparoscopic resection (LR) group with 30 in each.Endothelial-1 ( ET-1 ), yon Willebrand factor (vWF) , thrombomodulin ( TM), P-selectin (PS) and D-dimer (D-D) were determined 24 hours before, and 0 and 24 hours after the operation. At 0 hour after the operation, both OR and LR group showed significantly increased ET-1, vWF, and TM (P ＜ 0. 05 ), and the increase in the LR group was even more significant than that in the OR group (P ＜ 0.05). At 24 hours postoperation, no significant difference was found between the two groups in the levels of ET-l, vWF, and TM ( P ＞ 0. 05 ) , however both the groups showed significantly higher levels than preoperation ( P ＜ 0.05 ). At hour 0 after the operation,the levels of D-D and PS increased significantly in both the groups ( P ＜ 0.05 ) without significant difference between the groups ( P ＜0.05 ). The D-D and PS levels kept increasing at 24 hours postoperation, but OR group showed significantly higher increase than LR group ( P ＜ 0. 01 ). Conclusions Laparoscopic rectal carcinoma Miles procedure makes more serious injury to the vascular endothelial cells, but this injury does not last long. The variation of PS and D-D reminds us that the risk of developing deep venous thrombus is higher in the patients undergoing traditional open resection.