腹腔镜辅助胃癌根治术与开放手术治疗进展期胃癌患者的近期疗效及血清学检查结果比较

Comparison on the short-term effect and serological examination results of laparoscopic-assisted radical gastrectomy and open surgery in treatment of patients with advanced gastric cancer

摘要:

目的 探讨腹腔镜辅助胃癌根治术（LARG）与开腹胃癌根治术（ORG）治疗进展期胃癌（AGC）患者的近期疗效及血清学检查结果。方法 回顾性分析2017年10月－2019年10月于该院行胃癌根治术的60例AGC患者的临床资料，根据手术方式不同分为LARG组（n = 32）和ORG组（n = 28），检测两组患者手术前后血清炎性因子和T细胞亚群水平，比较两组患者术后并发症发生情况。结果 LARG组切口长度、肛门排气时间、下床活动时间、引流管拔管时间和住院时间均较ORG组短（P < 0.05），手术时间较ORG组长（P < 0.05），术中出血量较ORG组少（P < 0.05）；LARG组术后镇痛药物使用率（9.38%）低于ORG组（32.14%）（P < 0.05），术后1、3和7 d视觉模拟评分（VAS）低于ORG组（P < 0.05）；LARG组术后3和7 d白细胞介素-6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平均低于ORG组（P < 0.05），CD3⁺、CD4⁺、CD8⁺和CD4⁺/CD8⁺水平均高于ORG组（P < 0.05）；LARG组并发症发生率（3.12%）低于ORG组（21.43%）（P < 0.05）。结论 LARG治疗AGC效果确切，可降低血清炎性因子水平，对机体免疫功能影响较小，且术后并发症发生率较低。

Abstract:

Objective To explore the short-term effect and serological examination results of laparoscopic assisted radical gastrectomy (LARG) and open radical gastrectomy (ORG) in treatment of patients with advanced gastric cancer (AGC).Methods The clinical data of 60 AGC patients who underwent radical gastrectomy from October2017 to October 2019 were retrospectively analyzed. They were divided into LARG group (n = 32) and ORG group (n = 28) according to different surgical methods. The levels of serum stress inflammatory factors and T cell subsets in both groups before and after surgery were detected. The occurrence of postoperative complications was compared between the two groups.Results The incision length, anal exhaust time, time of ambulation, extubation time of drainage tube and hospitalization time in LARG group were shorter than those in ORG group (P < 0.05), operation time was longer than that in ORG group (P < 0.05), and intraoperative blood loss was less than that in ORG group (P < 0.05). The postoperative utilization rate of analgesic drugs in LARG group was lower than that in ORG group (9.38% vs 32.14%) (P < 0.05), and scores of visual analogue scale (VAS) 1 d, 3 d and 7 d after surgery were lower than those in ORG group (P < 0.05). Levels of interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in LARG group were lower than those in ORG group (P < 0.05) 3 d and 7 d after surgery, while levels of CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ were higher than those in ORG group (P < 0.05). The incidence of complications in LARG group was lower than that in ORG group (3.12% vs 21.43%) (P < 0.05).Conclusion The curative effect of LARG is significant on AGC, which can reduce levels of serum stress inflammatory factors, with fewer effects on immune function and low incidence of postoperative complications.