腹腔镜下与开腹胃癌D2根治术近期临床疗效及对血清炎症因子水平的影响

摘要

目的：：比较腹腔镜下与开腹胃癌D2根治术近期临床疗效，以及血清炎症因子水平变化情况。方法：收集符合标准的患者60例，结合患者及家属意愿分为腹腔镜组32例和开腹组28例，记录两组患者手术切除情况、术后恢复情况，以及术前及术后3d 血清 C－反应蛋白( CRP )、白细胞介素－6( IL－6)和肿瘤坏死因子－α( TNF－α)。结果：两组患者清扫淋巴结总数、远切端距肿瘤距离及近切端距肿瘤距离相似，差异均无统计学意义( P>0.05)。腹腔镜组患者术中出血量、术后肛门排气时间、术后下床活动时间、术后进流质饮食时间及术后住院时间均优于开腹组，差异有统计学意义( P<0.05)。两组患者术前血清CRP、IL－6及TNF－α水平相似，差异无统计学意义( P>0.05)；术后3d，腹腔镜组患者血清CRP、IL－6及TNF－α水平均低于开腹组，差异有统计学意义( P<0.05)。腹腔镜组是并发症发生率6.25％，低于开腹组的32.14％，差异有统计学意义( P<0.05)。结论：腹腔镜下胃癌D2根治术创伤小，淋巴结清除彻底，术后炎性反应轻，近期临床效果好，有利于患者康复。%Objective:To compare the short-term clinical efficacy between laparoscopic and open D2 radical operations for carcinoma of stomach and the changes in serum inflammatory factor levels. Methods:Totally 60 eligible patients were collected and divided into laparoscopic group ( 32 patients) and open group ( 28 patients) based on the wills of the patients and the families. The surgical resection conditions, postopera-tive recovery conditions, and serum levels of C reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α ( TNF-α) before the surgeries and at 3d after the surgeries in the patients of the two groups were recorded. Results: The patients of the two groups had insignificantly different total numbers of cleared lymph nodes, distances between the distal resection ends and the tumors, and distances between the proximal resection ends and the tumors ( P>0.05) . The laparoscopic group had significantly better intraoperative blood loss, postoperative times to passage of gas by anus, to out-of-bed activity, and to eating liquid diet, and postoperative length of stay than those in the open group (all P<0.05). Before the surgeries, the patients of the two groups had insignificantly different serum levels of CRP, IL-6 and TNF-α (P>0.05); 3 days after the surgeries, the laparoscopic group had significantly lower serum levels of CRP , IL-6 and TNF-α than those in the open group ( P<0.05) . The laparoscopic group had significantly lower complication incidence than the open group (6.25% vs. 32.14%, P<0.05). Conclusion:Laparoscopic D2 radical operation for carcinoma of stomach causes small wound, clears lymph nodes thoroughly, has mild postoperative inflammatory reactions and good short-term clinical efficacy, and is beneficial to the rehabilitation.