高凝状态相关指标在结直肠癌患者手术前后的变化及术式的影响
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陈永杰, Email: 6832966@qq.com

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广东省深圳市科技计划资助项目(201203276)。


Pre- and postoperative changes of parameters related to hypercoagulability in colorectal patients and the influence of mode of operation
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    摘要:

    目的:探讨结直肠癌患者手术前后高凝状态相关指标的变化,以及不同手术方式对其的影响。 方法:74例结直肠癌患者随机分为开腹组、腔镜组,分别行传统开腹手术和腹腔镜手术,并以37例健康查体者作为对照组,检测对照组以及手术前后两组结直肠癌患者血清D-二聚体、纤溶酶原激活物抑制物1(PAI-1)、凝血酶原片段1+2(F1+2)及蛋白C水平。 结果:与健康对照者比较,结直肠癌患者的术前D-二聚体、PAI-1、F1+2表达水平明显升高,而蛋白C水平明显降低(均P<0.05);与术前比较,两组结直肠癌患者术后D-二聚体、蛋白C水平升高,而PAI-1、F1+2水平降低(均P<0.05);术后腔镜组D-二聚体、蛋白C水平与开腹组差异无统计学意义(均P>0.05),但PAI-1、F1+2水平高于开腹组(均P<0.05)。 结论:结肠癌患者血液呈高凝状态,术后情况改善,但腹腔镜手术可能对某些指标产生短暂的不利影响,应予重视。

    Abstract:

    Objective: To investigate the alterations in parameters related to hypercoagulability in colorectal patients before and after operation, and the influence of different types of operation on these parameters. Methods: Seventy-four patients with colorectal cancer were equally randomized into open surgery group and laparoscopic group, and then underwent conventional open surgery and laparoscopic resection, respectively. Thirty-seven subjects undergoing health maintenance examination served as control group. The serum levels of D-dimer, plasminogen activator inhibitor-1 (PAI-1), prothrombin fragment 1+2 (F1+2) and protein C in control group and the two groups of colorectal cancer patients before and after operation were measured. Results: Compared with healthy controls, the levels of D-dimer, PAI-1 and F1+2 were significantly increased, while the protein C level was significantly decreased in colorectal cancer patients (all P<0.05). In both groups of colorectal cancer patients, the levels of D-dimer and protein C were elevated, and the levels of PAI-1 and F1+2 were reduced compared with those values before operation (all P<0.05). The postoperative levels of D-dimer and protein C showed no statistical difference between laparoscopic group and open surgery group (both P>0.05), but the levels of PAI-1 and F1+2 in laparoscopic group were higher than those in open surgery group (both P<0.05). Conclusion: Colorectal patients have a hypercoagulable state that can improve after surgical resection. However, laparoscopic resection may probably exert a temporary and unfavorable influence on some hypercoagulable parameters, and this should be given due attention.

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庄华章,陈永杰.高凝状态相关指标在结直肠癌患者手术前后的变化及术式的影响[J].中国普通外科杂志,2014,23(4):458-461.
DOI:10.7659/j. issn.1005-6947.2014.04.011

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  • 收稿日期:2013-08-12
  • 最后修改日期:2014-03-19
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  • 在线发布日期: 2014-04-15