快速康复外科对腹腔镜结直肠癌手术患者胰岛素抵抗和炎性反应的影响

发布时间：2018-05-13 02:32

本文选题：结直肠肿瘤 + 快速康复外科　；参考：《中国微创外科杂志》2017年05期

【摘要】：目的探讨快速康复外科(fast track surgery,FTS)对腹腔镜结直肠癌手术患者胰岛素抵抗(insulin resistance,IR)和炎性应激反应的影响。方法将2013年2月~2015年6月62例腹腔镜结直肠癌手术患者按随机数字表法分为FTS组和非FTS组,各31例,比较2组患者术后肛门排便、排气时间,术后住院时间,住院总费用和手术并发症。术前(T_0),术后第1、3、7天(T_1、T_3、T_7)4个时点检测2组胰岛素抵抗及炎性反应指标,包括空腹血糖(fasting blood-glucose,FBG)、空腹胰岛素(fasting insulin,FINS)、白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)和肿瘤坏死因子(tumor necrosis factor,TNF-α),采用稳态模式评估法(homeostasis model assessment,HOMA)计算胰岛素抵抗指数(HOMA-IR)。结果 FTS组患者术后肛门首次排气时间、排便时间显著短于非FTS组(t=3.088,P=0.003;t=4.227,P=0.000),术后住院时间、住院总费用显著低于非FTS组(t=3.937,P=0.000;t=3.478,P=0.003),2组并发症发生率无统计学差异(χ~2=0.267,P=0.605)。2组患者T_1、T_3时点上述炎性指标和IR指标均较T0时点明显升高(P均0.05);在T_1、T_3时点,与FTS组比较,非FTS组IL-6、CRP、TNF-α、FINS和HOMA-IR升高更明显(P0.05),血FBG升高不明显(T_1:t=0.870,P=0.388;T_3:t=0.870,P=0.388)。2组患者T_7时点IL-6和TNF-α基本恢复到T0时点水平(P均0.05),CRP、FBG、FINS和HOMA-IR值仍高于T_0水平(P均0.05);FTS组患者T_7时点血IL-6、TNF-α、FBG、FINS和HOMA-IR值与非FTS组比较无统计学差异(P0.05),血CRP明显低于非FTS组(t=-4.527,P=0.000)。结论 FTS用于腹腔镜结直肠癌手术可促进患者早期胃肠道功能恢复,减轻应激反应,降低术后IR,有效加速术后康复。
[Abstract]:Objective to investigate the effects of fast track surgeryus (FTS) on insulin resistance and inflammatory stress in patients undergoing laparoscopic colorectal cancer surgery. Methods from February 2013 to June 2015, 62 patients undergoing laparoscopic colorectal cancer surgery were randomly divided into FTS group and non-FTS group (31 cases each). The postoperative anal defecation, exhaust time and postoperative hospitalization time were compared between the two groups. Total hospitalization costs and surgical complications. Before operation, and on the 1st day after operation, 7 days after operation, the levels of insulin resistance and inflammatory response in two groups were detected at 4 time points: 1 / T / T / T / T / T / T / T / T / T / T / T / T / T / T _ 7). These include fasting blood glucose, fasting insulin, interleukin-6, interleukin-6 and tumor necrosis factor-TNF- 伪. The homeostasis model assessment method was used to calculate the insulin resistance index (HOMA-IRM). Results the first time of anal exhaust and defecation time in FTS group were significantly shorter than those in non-FTS group. The total cost of hospitalization was significantly lower than that in the non-FTS group (3.937 / 0.000) and there was no significant difference in the incidence of complications between the two groups (蠂 ~ (2 +) 0.267P ~ (0.605). The above inflammatory indexes and IR indexes were significantly higher at T _ (1) and T _ (3) than those at T _ (0) (P < 0.05), and at T _ 1 / T _ 3, they were significantly higher than those in the FTS group. The increase of TNF- 伪 fins and HOMA-IR in non-FTS group was more obvious than that in T0 time group (P < 0.05), but the increase in serum FBG level was not significant in T1: T0.870P0.388P0. 8: T3: t0.870P0. 3882.Group of patients in the non-FTS group had a significant return to the T0 time level of IL-6 and TNF- 伪 at T0 time (P < 0.05). The levels of IL-6 and HOMA-IR were still higher than those of the T0 level P = 0.055.The levels of IL-6TNF- 伪 FBGFINS and HOMA-IR in the FTS group were still higher than those in the non-FTS group at 7: 00. The levels of IL-6TNF- 伪 FBGFINS and HOMA-IR were higher than those in the non-FTS group. There was no significant difference in blood CRP between the two groups (P 0.05), and the blood CRP was significantly lower than that in the non-FTS group (P < 0.05), and was significantly lower than that in the non-FTS group (P = 0.000). Conclusion Laparoscopic colorectal cancer surgery with FTS can promote the early recovery of gastrointestinal function, reduce stress response, reduce postoperative IRI, and accelerate postoperative recovery.
【作者单位】：上海梅山医院普通外科;
【基金】：南京市科研发展项目(项目编号:YKK12220)
【分类号】：R735.34

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