腹腔镜辅助全胃切除术与开腹胃切除术+D2清扫术治疗胃上部癌的效果及对患者应激反应的影响

Effects of laparoscope assisted total gastrectomy and open gastrectomy combined with D2 dissection in the treatment of upper gastric cancer and the impact on stress response

摘要:

探讨腹腔镜辅助全胃切除术（LATG）与开腹胃切除术（OTG）＋D2清扫术治疗胃上部癌的效果及对患者应激反应的影响。方法 选取2014年6月-2017年6月该院胃肠外科行全胃切除术的胃上部癌患者145例为研究对象，依据手术方式不同将其分为研究组（行LATG术，n =70）、对照组（行OTG术＋D2清扫术， n=75），比较两组手术一般情况、手术应激指标皮质醇（Cor）、C反应蛋白（CRP）及术后恢复情况与并发症发生率。结果 研究组手术时间较对照组长，而切口长度、术中出血量、住院时间小/短于对照组（P <0.05），两组淋巴结清扫数目比较差异无统计学意义（P >0.05）；研究组术中、术后3 d血清Cor、CRP水平低于对照组（P <0.05）；研究组首次排气时间、恢复流质饮食时间短于对照组（P <0.05），两组术后二次手术率、30 d内再入院率比较差异无统计学意义（P >0.05），研究组术后6个月并发症发生率低于对照组（P <0.05）。结论 LATG术与OTG＋D2清扫术相比，具有创伤小、排气与进食早、应激反应少等优势，患者术后恢复快、并发症少，值得在临床推广实践。

Abstract:

Abstract: Objective To investigate the effects of laparoscope assisted total gastrectomy (LATG) and open total gastrectomy (OTG) combined with D2 dissection in the treatment of upper gastric cancer and the impact on stress response. Methods 145 patients with upper gastric cancer who underwent total gastrectomy from June 2014 to June 2017 were selected as research subjects, and they were divided into study group (treated by LATG, n = 70) and control group (treated by OTG + D2 dissection, n = 75) according to different surgical methods. The general condition of surgery, stress indexes cortisol (Cor), C reactive protein (CRP), postoperative recovery and the incidence of complications were compared between the two groups. Results The surgical time of the study group was longer than that of the control group, while the length of incision, intraoperative blood loss and length of hospital stay were shorter/less than those of the control group (P < 0.05). There was no significant difference in the number of dissected lymph nodes between the two groups (P > 0.05). Serum Cor and CRP levels in the study group were lower than those the control group during surgery and at 3 d after surgery (P < 0.05). The initial exhaust time and recovery time of liquid diet in the study group was shorter than that in the control group (P < 0.05), but there was no significant difference between the two groups in the rate of second surgery and readmission rate within 30 days (P > 0.05). The incidence of complications in the study group at 6 months after surgery was lower than that in the control group (P < 0.05). Conclusion Compared with OTG and D2 dissection, LATG has advantages of less trauma, earlier exhaust and feeding and fewer stress reactions, with quick recovery and few complications.