CAJ | 학술논문

目的探讨腹腔镜结直肠癌根治术对腹膜微结构损伤和腹膜纤维溶解分子表达的影响.方法前瞻性纳入2011年6月至2012年2月间山西省人民医院收治的50例结直肠癌患者,根据患者意愿和医生决策分为腹腔镜组(27例)和开腹组(23例).分别在光镜和电镜下观察术后腹膜微结构损伤程度；采用ELISA法比较手术前后腹膜组织型纤溶酶原激活物t-PA和纤溶酶原激活物抑制因子1(PAI-1)水平的改变.结果术后标本光镜和电镜观察显示,开腹组肠管浆膜完整性受损、系膜脂肪细胞与间皮细胞覆盖脱失、炎性细胞聚集程度较腹腔镜组严重,两组损伤评分比较的总平均秩次分别为38.22和14.67,差异有统计学意义(P＜0.01).术后网膜组织t-PA、肠管浆膜组织t-PA及PAI-1水平的差异均无统计学意义(均P＞0.05)；但腹腔镜组网膜组织中PAI-1水平显著低于开腹组(P＜0.05).结论相对于开腹手术,腹腔镜结直肠癌根治术腹膜损伤程度较轻,对腹膜纤溶功能的影响较小,有利于防止肠粘连的形成.
목적 탐토복강경결직장암근치술대복막미결구손상화복막섬유용해분자표체적영향.방법 전첨성납입2011년6월지2012년2월간산서성인민의원수치적50례결직장암환자,근거환자의원화의생결책분위복강경조(27례)화개복조(23례).분별재광경화전경하관찰술후복막미결구손상정도；채용ELISA법비교수술전후복막조직형섬용매원격활물t-PA화섬용매원격활물억제인자1(PAI-1)수평적개변.결과 술후표본광경화전경관찰현시,개복조장관장막완정성수손、계막지방세포여간피세포복개탈실、염성세포취집정도교복강경조엄중,량조손상평분비교적총평균질차분별위38.22화14.67,차이유통계학의의(P＜0.01).술후망막조직t-PA、장관장막조직t-PA급PAI-1수평적차이균무통계학의의(균P＞0.05)；단복강경조망막조직중PAI-1수평현저저우개복조(P＜0.05).결론 상대우개복수술,복강경결직장암근치술복막손상정도교경,대복막섬용공능적영향교소,유리우방지장점련적형성.
Objective To assess the influence of laparoscopic colorectal cancer resection on the peritoneal microstructure injury and expression of t-PA/PAI-1 molecules.Methods A total of 50 patients with colorectal cancer were prospectively enrolled between June 2011 and February 2012 in the Shanxi Provincial Hospital and were assigned into laparoscopic group (LO,n=27) and conventional laparotomy group (CO,n=23) based on patients expectancy and surgeon decision.Optical microscope and scanning electron microscope were employed for comparison of the postoperative peritoneal injury between LO and CO.Before and after surgery,t-PA and PAI-1 of peritoneal tissue were determined by ELISA in both groups.Results Optical microscope and scanning electronic microscopy scan indicated less serosal injury in LO group than that in CO group with regard to serosa integrity,continuity of covering adipocytes and mesothelial cells,and the aggregation level of inflammatory cells(P＜0.01 ).The injury score was 38.22 in CO in and 14.67 in LO and the difference was statistically significant (P＜0.01 ).No significant differences were found between LO and CO in terms of postoperative t-PA in the omentum,t-PA and PAI-1 in the intestinal serosa tissue(P＞0.05),however PAI-I in the omentum was significantly lower in LO group compared to CO group (P＜0.05).Conclusion Laparoscopic radical resection for colorectal cancer causes less peritoneal structural injury and less influence on the fibrinolytic capacity,which may contribute to less postoperative adhesion.