术中腹内压增加对大肠癌微创手术患者消化系统影响的研究

Impact of increasing intra-abdominal pressure on digestive system during colorectal cancer patients under minimally invasive surgical procedure

摘要:

目的??探究术中腹内压增加对大肠癌微创手术患者消化系统的影响。方法 回顾性分析2013年1月-2016年6月该院收治的132例经腹腔镜大肠癌根治手术治疗的大肠癌患者的临床资料。根据患者术中采用的腹内压将患者分为A组、B组和C组。A组46例患者为10 mmHg（1 mmHg=0.133 kPa），B组45例患者为12 mmHg，C组41例患者为15 mmHg。比较3组患者术后各项恢复时间、并发症情况和血清细胞因子水平。结果 3组患者术后6 h内拔出鼻胃管例数、肠蠕动恢复时间、首次肛门排气或排便时间、耐受半流质饮食时间、术后腹泻持续时间和术后住院时间差异均无统计学意义（P >0.05）。术后3组患者急性胃肠损伤（AGI）、乳糜漏、吻合口瘘、术区渗血、肠麻痹和术后呕吐发生率差异均无统计学意义（P >0.05）。术后3组患者的白细胞介素-6（IL-6）和平均动脉压（MAP）较术前均明显升高，差异有统计学意义（P <0.05）。术前3组患者的肿瘤坏死因子-α（TNF-α）较术后差异无统计学意义（P >0.05）。术后25例肠麻痹患者血清IL-6水平为（10.71±4.37）ng/L，107例未发生肠麻痹患者的血清IL-6水平为（10.66±4.13）ng/L，差异无统计学意义（P >0.05）。结论 术中腹内压增加对大肠癌微创手术患者消化系统没有显著影响。

Abstract:

Objective?To investigate the impact of intraoperative intra-abdominal pressure increasing on digestive system.?Methods?A retrospective analysis of clinical data of 132 cases of colorectal cancer patients from January 2013 to June 2016 was made. Patients were divided into groups A, B and C according to the intra-abdominal pressure, 46 cases in each group. Group A: 46 patients, 10 mmHg (1 mmHg = 0.133 kPa), group B: 45 patients, 12 mmHg, group C: 41 patients, 15mmHg. Comparison of postoperative recovery time, complications, serum cytokine levels was made among the three groups.?Results?The number of postoperative 6h nasogastric tube pulled out, bowel recovery time, first flatus or a bowel movement, tolerance semi-liquid diet, postoperative duration of diarrhea, postoperative hospitalization time among the three groups show no statistically difference (P > 0.05). The difference of acute gastric injury (AGI), chyle leakage, anastomotic fistula, surgical bleeding, intestinal paralysis, vomiting incidence of postoperative among the three groups has no statistically differences (P > 0.05). While postoperative IL-6 level and MAP were significantly increased compare with preoperative level, the difference was statistically significant (P < 0.05). Postoperative TNF-α show no statistical differences compare with preoperative (P > 0.05). Postoperative serum IL-6 levels in 25 patients with intestinal paralysis was (10.71 ± 4.37) ng/L, 107 cases had high serum IL-6 levels in patients did not occur intestinal paralysis was (10.66 ± 4.13) ng/L, the difference was not statistically significance (P > 0.05).?Conclusion?Intra-abdominal pressure increasing during minimally invasive surgical procedure has no significant effect on the digestive system in colorectal cancer patients.