| ObjectiveColorectal cancer is one of the malignant tumor of digestive tract with high morbidty, which has a intensive disease rate have had a tendency of increase for the past few years. Surgical operation is the most effective treatment. In recent years, laparoscopic surgery has been developing rapidly allover the world. Many studies indicated that laparoscopic colorectal operation was as effective as laparotomy and had significant advantages such as milder pain, less abdominal interference, less complication, more rapid rehabilitation, and shorter length of stay. Laparoscopic surgery has effect on immune, neuroendocrine and metabolic reaction as laparotomy. Some studies have proved that changes of serum endothelin(ET) might be an important index for evaluating the magnitude of suigical stress response. Furthemore, concentration of ET and nitrogen monoxidum(NO) in peripheral blood may be useful in the evaluation of trauma. Serum interleukin-6(IL-6) and C-reactive protein(CRP) levels increased significantly after operation, they are proportional to the severity of surgical trauma and sensitive indexes of reflecting degree of injury. IL-6 can accommodates humoral-mediated immunity and cell-mediated immunity. In this study, the endothelin(ET),nitrogen monoxidum(NO),interleukin-6(IL-6) and C-reactive protein(CRP) level pre- and post-operation were contrasted between the patients received laparoscopic colectomy and laparocolectomy, in order to investigate the effects of the physical stress impacted by the two therapies.Methods1.Objects: 35 patients suffering colorectal cancer in our department, from Jun. 2006 to March. 2007 were examined. 15 of them accepted laparoscopy-assisted colectomy (laparoscopic group) and 20 patients who didn't accepte laparoscopy were performed with laparocolectomy ( laparotomy group). Pationt's in both groups were not complicated with complication,infusion reaction,vital organic and systemic diseases(hypertensive disease, diabetes mellitus, anginosis, chromaffin tumor, hyperthyreosis, Symptomatic atherosclerotic, chronic nephritis, liver cirrhosis, coronary artery disease, helcenteritis, virus hepatitis, duodenal ulcer, etc.). The patients were undergone anesthesia with tracheal intubation com-bined with intravenous anesthesia. Gender, age, height, body weight , modus operandi and postoperative pathological staging of the patients were similar between the two groups.2.Methods: Prospective study were adopted. Radioimmnnology(RAI),Nitrale reduetase(NR) and nepheloturbidity were used to detect of ET,IL-6,NO and CRP levels at pre- and post-operation,the 1st, 2nd, 3rd and 5th day after operation in two groups.3.Statistical analysis: All data were processed by SPSS11.0 software package. T test was used for analysing Pre- and post-operative measurement data. The data were expressed as mean±standard deviation( ). Correlation between two variables was performed by means of linear regression. There is considered to be statistical significant when p<0.05.Results1.ET: No statistical significant deference between the two groups on ET level pre-operation was found. ET level of post-operation of laparoscopic group was lower than pre-operation's, but there was had no significant deference; ET level of 1st day post-operation was significantly lower than pre-operation's(p<0.05); ET level of 2nd day post-operation started to raise and were still lower than pre-operation's markedly(p<0.05), which restored to pre-operation at the 3rd day after operation . ET levels between pre- and post-operation of laparotomy group had no significant deference. ET levels of post-operation of both two groups had no statistical significance.2.NO: No statistical significant deference between the two groups on NO level pre-operation was found. NO level of post-operation in both groupswere lower than pre-operation's significantly (p<0.01). The NO level of the laparotomy group restored to pre- operation's at the 2nd day after operation, was higher than the level of laparoscopic group markedly (p<0.01), which restored to previous at the 3rd day after operation.3.IL-6: No statistical significant deference between the two groups on IL-6 level pre-operation was found. IL-6 levels of post-operation of the two groups were higher than pre-operation's significantly(p<0.01), and IL-6 level of the laparoscopic group was lower than the laparotomy group markedly (p<0.01), IL-6 level of restored to previous at the 5th day after operation, at the same time IL-6 levels between two groups still had statistical significant deference(p<0.05).4.CRP: No statistical significant deference between the two groups on CRP level pre-operation was found. CRP levels of post-operation in the two groups were higher than pre-operation's significantly(p<0.01). CRP levels of 5th day after operation in both groups were higher than pre-operation's significantly(p<0.05; p <0.01),and CRP levels between two groups had statistical significant deference.(p<0.05). ConclusionsLaparoscopic colectomy causes less effects on ET,NO,IL-6 and CRP than laparotomy in patients.Compared with laparotomy, the laparoscopic colectomy imposes less impact on physical stress. |
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