高糖溶液对腹腔镜结直肠癌术后胃肠功能恢复、炎症反应及并发症的影响

Effect of high glucose solution on gastrointestinal function recovery, inflammatory reaction and complications after laparoscopic colorectal cancer surgery

摘要:

目的 探讨高糖溶液对腹腔镜结直肠癌术后胃肠功能恢复、炎症反应及并发症的影响。方法 选择2019年1月－2021年1月该院收治的拟行腹腔镜下结直肠癌手术的患者64例，随机分为高糖组和对照组，各32例。两组患者的腹腔镜下结直肠癌手术均由同组医师完成，高糖组术前3 h口服400 mL 12.5%葡萄糖溶液。对比两组患者术后胃肠功能恢复情况，以及围术期肿瘤坏死因子-α（TNF-α）、高迁移族蛋白B1（HMGB1）、空腹血糖（FPG）、胰岛素、内毒素、稳态模型的胰岛素抵抗指数（HOMA-IR）和胰岛素样生长因子-Ⅰ（IGF-Ⅰ）的变化，并记录两组患者术后并发症的发生情况。结果 高糖组术后排气时间、首次排便时间和住院时间短于对照组，胃管留置率低于对照组，差异均有统计学意义（P < 0.05）。两组患者术后1和3 d血清TNF-α和HMGB1均较术前1 d升高；高糖组术后1和3 d血清TNF-α和HMGB1均低于对照组同期水平，差异有统计学意义（P < 0.05）。两组患者术后1和3 d血清FPG、胰岛素、内毒素和HOMA-IR均较术前1 d升高，IGF-Ⅰ较术前1 d下降；高糖组术后1和3 d血清FPG、胰岛素、内毒素和HOMA-IR均低于对照组同期水平，IGF-Ⅰ高于对照组同期水平，差异有统计学意义（P < 0.05）。高糖组术后并发症发生率为12.50%，较对照组的34.38%低，差异有统计学意义（P < 0.05）。结论 在腹腔镜结直肠癌根治术前口服高糖溶液，能够减轻术后炎症反应，减小血糖波动，有助于促进术后胃肠功能恢复，减少术后并发症发生。

Abstract:

Objective To explore the effect of high glucose solution on gastrointestinal function recovery, inflammatory reaction and complications of colorectal cancer patients after laparoscopic surgery.Methods Sixty-four patients with colorectal cancer underwent laparoscopic surgery from January 2019 to January 2021 were randomly divided into high glucose group and control group, with 32 cases in each group. Colorectal surgery in both groups was performed by doctors in the same group, and 400 mL of 12.5% glucose solution was taken orally in the high glucose group 3 hours before operation. The recovery of gastrointestinal function, perioperative changes of tumor necrosis factor-α (TNF-α), high mobility group protein B1 (HMGB1), fasting plasma glucose (FPG), insulin, endotoxin, homeostatic model assessment of insulin resistance (HOMA-IR) and insulin-like growth factor-I (IGF-I) were compared between the two groups, and the occurrence of postoperative complications was recorded.Results The postoperative exhaust time, first defecation time and hospitalization time in the high glucose group were shorter than those in the control group, gastric tube indwelling rate in the high glucose group was lower than that in the control group, with statistical significance (P < 0.05). The levels of serum TNF-α and HMGB1 in both groups on the first day after operation and the third day after operation were higher than those on the first day before operation. Serum TNF-α and HMGB1 in the high glucose group were lower than those in the control group on the 1st day and 3rd day after operation, and the difference was statistically significant (P < 0.05). The levels of serum FPG, insulin, endotoxin and HOMA-IR in the two groups on the 1st day and 3rd day after operation were higher than those on the 1st day before operation, and IGF-I was lower than that on the 1st day before operation. Serum FPG, insulin, endotoxin and HOMA-IR in the high glucose group were lower than those in the control group on the 1st day and 3rd day after operation, and IGF-I was higher than that in the control group at the same period, with statistical significance (P < 0.05). The incidence of postoperative complications in high glucose group was 12.50%, which was lower than that in control group (34.38%), and the difference was statistically significant (P < 0.05).Conclusion Oral administration of high-glucose solution before laparoscopic radical resection of colorectal cancer can reduce postoperative inflammatory reaction and blood sugar fluctuation, and help to promote the recovery of gastrointestinal function and decrease postoperative complications.