达芬奇机器人手术系统与腹腔镜及开腹胃癌根治术腹腔冲洗液癌胚抗原和多巴脱羧酶的变化

摘要

目的 探讨达芬奇机器人手术系统、腹腔镜及开腹胃癌根治术腹腔冲洗液CEA和多巴脱羧酶(DDC)的变化.方法 回顾性分析2013年1月至2014年3月第三军医大学西南医院收治的126例行胃癌根治术患者的临床资料,其中行达芬奇机器人手术系统胃癌根治术、腹腔镜胃癌根治术、开腹胃癌根治术者各42例,设为机器人手术组、腹腔镜手术组和开腹手术组.收集患者手术前后腹腔冲洗液,采用ELISA法检测CEA和DDC浓度.计量资料采用配对t检验及方差分析,多重比较采用LSD法,计数资料采用x2检验及非参数检验.结果 机器人手术组、腹腔镜手术组和开腹手术组患者术前腹腔冲洗液中CEA浓度分别为(242±189) μg/L、(221±174) μg/L和(257±135) iμg/L,术后CEA浓度分别为(1 262 ±785) μg/L、(1 172 ±699) μg/L和(2 996±1 947) μg/L;3组患者术前腹腔冲洗液中DDC浓度分别为(8±5) μg/L、(7±4) μg/L和(8±6) μg/L,术后DDC浓度分别为(87±55) μg/L、(81 ±52) μg/L和(146±135) lμg/L.3组患者术前CEA与DDC浓度比较,差异无统计学意义(F =0.491,0.161,P＞0.05);3组患者术后CEA与DDC浓度比较,差异有统计学意义(F =27.214,6.865,P＜0.05).两两比较术后CEA与DDC浓度发现:开腹手术组较腹腔镜及机器人组明显升高(P＜0.05),而腹腔镜手术组与机器人手术组比较,差异无统计学意义(P＞0.05).分析同种手术方式手术前后腹腔冲洗液中CEA和DDC浓度:3组术后CEA和DDC浓度均较术前显著增高,差异有统计学意义(t=-11.053、-11.700、-9.780,-10.261、-9.955、-6.969,P＜0.05).结论 达芬奇机器人手术系统胃癌根治术与腹腔镜胃癌根治术比较,术后腹腔冲洗液中CEA和DDC浓度差异无统计学意义,但均明显低于开腹胃癌根治术,对于防止CEA和DDC介导的胃癌腹腔转移可能有一定作用.%Objective To explore the change of carcinomacmbryonic-antigen (CEA) and dopa decarboxylase (DDC) in the peritoneal irrigation fluid from patients undergoing Da Vinic robotic,laparoscopic and open radical gastrectomy for gastric cancer.Methods The clinical data of 126 patients undergoing radical gastrectomy for gastric cancer at the Southwest Hospital from January 2013 to March 2014 were retrospectively analyzed.There were 42 patients in the Da Vinic robotic radical gastrectomy group (RRG group),42 in the laparoscopic radical gastrectomy group (LRG group) and 42 in the open radical gastrectomy group (ORG group).The preoperative and postoperative peritoneal irrigation fluids were collected,respectively.Concentrations of CEA and DDC in the peritoneal irrigation fluids were detected by the enzyme-linked immunosorbent assay (ELISA).The quantitative data were analyzed using the t test and the chi-squared test,the multiple comparison were analyzed using the least significance difference (LSD) and the count data were analyzed using the chi-square test and nonparametric test.Results The preoperative and postoperative concentrations of CEA in the RRG group,LRG group and ORG group were (242 ± 189)xg/L,(221 ± 174)μg/L,(257 ± 135) μg/L and (1 262 ± 785) μg/L,(1 172 ± 699) iμg/L,(2 996 ± 1 947) μg/L,respectively.The preoperative and postoperative concentration of DDC in the RRG group,LRG group and ORG group were (8 ±5)μg/L,(7 ±4)μg/L,(8 ±6)μg/L and (87 ±55) μg/L,(81 ±52) pg/L,(146 ± 135)μg/L,respectively.No significant differences were observed for the preoperative concentrations of CEA and DDC in the 3 groups (F =0.491,0.161,P ＞ 0.05),and the postoperative concentration of CEA and DDC in the 3 groups were significantly different (F =27.214,6.865,P ＜ 0.05).The postoperative concentration of CEA and DDC in the ORG group were significantly higher than those in the RRG group and LRG group (P ＜ 0.05),while no significant differences in the postoperative concentration of CEA and DDC were observed between the LRG group and RRG group (P ＞ 0.05).The preoperative and postoperative concentrations of CEA and DDC were significantly increased in all the 3 groups,with a significant difference when compared with the preoperative concentrations of CEA and DDC (t =-11.053,-11.700,-9.780,-10.261,-9.955,-6.969,P ＜0.05).Conclusion The postoperative concentration of CEA and DDC in the peritoneal irrigation fluid after Da Vinic robotic radical gastrectomy is significant decreased when compared with the open radical gastrectomy,while no significant difference is observed between the Da Vinci robotic radical gastrectomy and the laparoscopic radical gastrectomy,which is helpful for preventing CEA-and DDC-mediated abdominal metastasis of gastric cancer.