目的：比较腹腔镜和开腹结直肠癌手术对老年患者机体应激反应的影响。方法选择南京医科大学第二附属医院胃肠外科自2012年5月至2013年7月收治的老年结直肠癌患者78例，随机分为腹腔镜组42例和开腹组36例。比较2组围手术期血糖、胰岛素、白细胞介素⁃6（ IL⁃6）、C⁃反应蛋白（ CRP ）及相关临床指标的变化。结果腹腔镜组平均手术时间长于开腹组（ P＜0�05）；开腹组术中平均出血量多于腹腔镜组（ P＜0�05）。2组患者术后第1天血糖、IL⁃6和CRP均明显升高，胰岛素水平明显降低，术后第2天腹腔镜组血糖、胰岛素恢复到术前水平，开腹组于术后第3天恢复至术前水平。术后第3天腹腔镜组IL⁃6恢复至术前水平，开腹组明显高于腹腔镜组（P＜0�05）。术后第5天2组CRP仍显著高于术前水平（P均＜0�05），且开腹组高于腹腔镜组（P＜0�05）。%Objective To investigate the difference of systemic stress responses in the elderly patients receiving lap⁃aroscopic colectomy or open surgery. Methods Totally 78 patients with colorectal carcinoma in the Second Affiliated Hospital of Nanjing Medical University from May 2012 to July 2013 were analyzed. Forty⁃two patients underwent laparoscopy and other 36 patients underwent open surgery. Blood glucose (BG), insulin, interleukin⁃6(IL⁃6), C⁃reactive protein (CRP) levels and general clinical data in peri⁃operation stage were detected and compared between the two groups. Re⁃sults Mean operating time was longer in the laparoscopic group than that in the open group (P<0�05), blood loss was less in laparoscopic group ( P<0�05) . The levels of BG, IL⁃6 and CRP of the patients in both groups on the first day after operation were significantly increased;the insulin levels were decreased. The levels of BG and insulin of the patients in the laparoscopic group all resumed normal on the second day after operation, which resumed on the third day after operation in the open group. The level of IL⁃6 resumed to pre⁃operation level on the third day after operation, while it was still higher in the open group than that in the laparoscopic group ( P<0�05) . The CRP level of patients in both groups on the fifth day af⁃ter operation was still higher than that before operation ( P<0�05) , and it was higher in the open group than that in the lap⁃aroscopic group ( P<0�05) . Conclusions Compared with the open surgery, the laparoscopic operation is safe and feasi⁃ble in the elderly patients with colorectal cancer, and brings less effect to the systemic stress response in intensity and time.
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