不同手术方式对胃癌根治术患者炎症因子及凝血功能的影响

摘要

目的 比较腹腔镜与开腹两种手术方式对胃癌根治术患者炎症因子及凝血功能的影响.方法 选择2011年2月至2012年12月在我院外科行胃癌根治术的患者96例,按手术方法不同分为腹腔镜组38例和开腹组58例.分别于术前、术后4h和术后24h检测患者血清IL-6、IL-8和TNF-α水平.分别于术前及术后第1、3、5、7天检测患者凝血功能.结果 术后开腹组和腹腔镜组患者PT延长,APTT缩短,Fib升高,PLT术后第3天降低而术后第7天升高,与术前比较差异有统计学意义(P＜0.05).术前两组患者血清IL-6、IL-8和TNF-α水平差异无统计学意义(P＞0.05)；术后两组患者血清IL-6、IL-8和TNF-α水平与术前比较均明显升高(P＜0.05),但腹腔镜组患者血清IL-6、IL-8和TNF-α水平低于开腹组,差异有统计学意义(P＜0.05).术后1 dIL-6水平与IL-8水平含量呈正相关(r=0.75,P＜0.05).结论 腹腔镜辅助下胃癌根治术能够减少炎症介质的释放、抑制炎症反应及降低患者术后血栓的形成.%Objective To assess the effects of laparoscopic gastrectamy and open gastrectamy on serum inflammation levels and coagulation function in patients with gastric cancer undergoing gastrectamy.Methods According to different operation method,ninety-six patients with gastric cancer undergoing gastrectamy from Feb.2011 to Dec.2012 were divided into the laparoscopic group and open group.The patients of laparoscopic group were treated with laparoscopic gastrectamy,and those of the open group were treated with open gastrectamy.The levels of IL-6,IL-8 and TNF-α in serum were measured before operation,4 h and 24 h after operation.The levels of coagulation function were measured before operation,and one,three,five and seven days after operation.Results The levels of PT and Fib in serum were significantly increased in the two groups after operation (P＜0.05),and the levels of APTT was significantly decreased in the two groups after operation (P＜0.05).The levels of PLT were significantly decreased three days after operation,and significantly increased seven days after operation.There was no statistically significant difference in IL-6,IL-8 and TNF-α between the two groups before operation.The levels of IL-6,IL-8 and TNF-αwere significantly increased in the two groups after operation (P＜0.05).However,the levels of IL-6,IL-8 and TNF-α in the laparoscopic group were significantly less than those in the open group (P＜0.05).The levels of IL-6 and IL-8 were positively correlated one day after operation.Conclusion Laparoscopic gastrectamy can reduce the production of IL-6,IL-8 and TNF-α in serum,inhibit inflammatory reaction and decrease thrombosis in patients with gastric cancer after operation.