摘要
目的比较腹腔镜与开腹直肠癌根治术对直肠癌患者第三间隙效应的影响。方法选择直结肠癌根治术患者51例,将其随机分为腔镜组24例,开腹组27例,腔镜组采用腹腔镜手术,开腹组采用传统开腹手术,比较两组术后血清白蛋白、总蛋白、前白蛋白、Na^+、K^+、Ca^(2+)及术中、术后24、48、72 h的液体入量、出量(尿量)、入出量差值、腹腔引流量,观察术后尿量峰值和液体负平衡出现的时间、手术时间、术中出血量、住院时间。结果与开腹组相比,腔镜组手术时间稍长,术中出血量相对少,术后住院时间相对短(P均<0.05)。两组术后电解质(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均>0.05)。两组术后液体入量、液体入出量差值比较,差异无统计学意义(P均>0.05);而两组液体出量比较差异有统计学意义(P<0.05),且两组间液体出量、术后液体入出量差值随时间改变而变化(P<0.05),腹腔镜组术后24 h出现液体负平衡、尿量高峰较开腹组早,持续时间较长(P<0.05)。结论腹腔镜与开腹直肠癌根治术后均存在不同程度的液体、电解质异常分布情况,但腹腔镜手术患者术后尿量高峰、液体负平衡时间较开腹手术早,对第三间隙效应的影响较轻。
Objective To compare the effects of laparoscopic radical surgery and open radical surgery on the third gap effect in patients with rectal cancer. Methods Fifty-one patients undergoing radical surgery of rectal cancer were divided into the laparoscopic group（ n = 24） and open surgery group（ n = 27）. The levels of serum albumin,total protein and prealbumin,and electrolytes（ Na＋,K＋,Ca2＋） were compared between two groups after operation. Meanwhile,the fluid infusion volume,fluid output volume（ urine volume）,and difference between fluid infusion and fluid output volume,and abdominal drainage during operation,and at 24,48 and 72 h after operation,were compared between two groups. The time for the postoperative urine volume peak and negative fluid balance,the operative duration,intraoperative blood loss and hospital stay were also observed in the two groups. Results Compared with the open surgery group,the laparoscopic group had longer operative duration,less intraoperative blood loss and less hospital stay（ all P〈0. 05）. There were no differences in the levels of electrolytes（ Na＋,K＋,Ca2＋）,serum albumin,total protein,or prealbumin between two groups（ all P〈0. 05）. No differences in the fluid infusion volume or the difference between operative fluid infusion and fluid output volume were found between these two groups（ both P〈0. 05）. There was a significant difference in the fluid output volume between two groups（ P〈0. 05）,and the fluid output and the difference between operative fluid infusion and fluid output volume changed with the different time period in both of the two groups（ P〈0. 05）. The peak of urine volume and the peak of negative fluid balance appeared at 24 h after operation in the laparoscopic group,which was earlier and lasted longer as compared with that in the open surgery group（ P〈0. 05）. Conclusion Postoperative abnormal distribution of liquid and electrolyte induced by the third space effect were both found in patients undergoing the laparoscope and open surgery. But in the laparoscopic radical surgery of rectal cancer,the peak of urine volume and the negative fluid balance appeared earlier,and the effect of the third space was less.
作者
汪龙
麦威
李雷
王晓通
钟晓刚
黄顺荣
WANG Long;MAI Wei;LI Lei;WANG Xiaotong;ZHONG Xiaogang;HUANG Shunrong(The People＇ s Hospital of Guangxi Zhuang Autonomous Region,Nanning 530021,China)
出处
《山东医药》
CAS
2018年第25期5-8,共4页
Shandong Medical Journal
基金
国家自然科学基金资助项目(81360369)
广西卫生厅科研课题(Z2015362)
关键词
直肠癌
腹腔镜
开腹
第三间隙效应
rectal carcinoma
laparoscope
open surgery
the third space effect
