摘要
目的比较腹腔镜与开腹结直肠癌根治术对患者术后第三间隙效应的影响。方法选择结直肠癌根治术患者49例,其中腹腔镜组21例,开腹组28例,比较两组患者术后血清白蛋白、总蛋白、前白蛋白、电解质情况以及两组术中、术后24 h、48 h及72 h的液体入量、出量(尿量)及入出量差值的变化情况,观察术后尿量峰值出现时间、手术时间、术中出血量、住院时间。结果与开腹组比较,腹腔镜组手术时间长,术中出血少,术后住院时间短(P<0.05)。两组患者术后电解质(Na^+、K^+、Ca^(2+))、白蛋白、前白蛋白及总蛋白水平比较,差异无统计学意义(P>0.05)。两组间的液体入量比较,差异有统计学意义(P<0.05),两组液体入量随时间延长而变化(P<0.05);两组间的液体出量比较,差异有统计学意义(P<0.05),腹腔镜组术后24 h出现尿量高峰,较开腹组早、持续时间较长。两组患者术后液体入出量差比较,差异无统计学意义(P>0.05),腹腔镜组术后24 h出现液体负平衡,较开腹组早。结论开腹、腔镜结直肠癌根治术后第三间隙效应都存在不同程度的液体、电解质异常分布情况,但腹腔镜结直肠癌根治术后尿量高峰、液体负平衡时间较开腹手术提前,术后住院时间短,恢复更快。
Objective To compare the postoperative third space effects of laparoscopic radical surgery and open radical surgery for patients with colorectal cancer.Methods Forty-nine patients undergoing radical surgery of colorectal cancer were divided into laparoscopic group（n=21）and open group（n=28）.The levels of serum albumin,total protein,prealbumin and electrolytes were compared between two groups after operation.During operation,24,48 and 72 hours after operation,the comparisons of fluid infusion volume,fluid output volume （urine volume） and difference between fluid infusion and output volumes were conducted between two groups.The time for the postoperative urine volume peak,operative duration,intraoperative blood loss and hospital stay were also observed in two groups.Results Compared to open group,laparoscopic group obtained longer operative duration,less intraoperative blood loss and less hospital stay（P〈0.05）.There were no significant differences in the levels of electrolytes（Na^＋,K^＋and Ca^2＋）,albumin,prealbumin or total protein between two groups after operation（P〉0.05）.There was a significant difference in the fluid infusion volume between two groups（P〈0.05）,the fluid infusions changed with the increasing time in both groups（P〈0.05）.There was a significant difference in the fluid output volume between two groups （P〈0.05）.The peak of urine volume appeared 24 hours after operation in the laparoscopic group,and it was earlier and lasted longer compared to that in the open group.And the difference between postoperative fluid infusion volume and output volume showed no significant difference between two groups（P〉0.05）.The peak of negative fluid balance appeared 24 hours after operation in the laparoscopic group,which was earlier than that in the open group.Conclusion Postoperative abnormal distribution of liquid and electrolyte induced by the third space effect exists in both of laparoscopic radical surgery and open surgery of colorectal cancer.But in the laparoscopic radical surgery of colorectal cancer,the peak of urine volume and the negative fluid balance appear earlier,the postoperative hospital stay is shorted,postoperative recovery is fasted.
出处
《广西医学》
CAS
2015年第10期1387-1390,共4页
Guangxi Medical Journal
基金
国家自然科学基金(81360369)
广西医药卫生科研课题(Z2015362)
关键词
结肠癌
直肠癌
腹腔镜
开腹
根治术
第三间隙效应
Colon cancer
Rectal cancer
Laparoscopic surgery
Open surgery
Radical surgery
Third space effect
