腹腔镜胃癌根治术治疗进展期胃癌及对患者相关指标的影响
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摘要
目的探讨腹腔镜胃癌根治术治疗进展期胃癌及对患者相关指标的影响。方法选取本院2015年1月至2018年12月收治的90例进展期胃癌作为研究对象,采用随机数字法分为观察组和对照组,各45例,其中对照组进行常规开腹手术,观察组则进行腹腔镜胃癌根治术。观察并记录两组患者的手术一般情况,包括术中出血量、手术时间、术后排气时间、下床活动时间以及住院时间;记录并比较两组患者术后6 h、12 h、24 h、48 h的VAS评分;检测并比较两组患者术后CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、NK等免疫功能指标;观察并比较两组患者术后并发症的发生情况。结果观察组患者术中出血量、手术时间、术后排气时间、下床活动时间以及住院时间均明显小于对照组,差异均具有统计学意义(P<0.05)。观察组患者术后6 h、12 h、24 h、48 h的VAS评分明显低于对照组,差异均具有统计学意义(P<0.05)。两组患者术后的CD3~+、CD8~+数值比较,差异无统计学意义;观察组患者术后CD4~+、CD4~+/CD8~+、NK数值均明显优于对照组,差异具有统计学意义(P<0.05)。观察组患者术后切口感染1例、肺部感染1例;对照组患者术后切口感染3例,腹腔感染2例,尿路感染2例、肺部感染和吻合口瘘各1例;观察组术后不良反应发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论腹腔镜胃癌根治术治疗进展期胃癌效果显著,不仅对患者的免疫功能影响较小,而且还能降低患者的术后疼痛,减少术后并发症的发生。
Objective To investigate the effect of laparoscopic radical gastrectomy on advanced gastric cancer and related indicators. Methods 90 cases of patients with advanced gastric cancer admitted to our hospital from January 2015 to December 2018 were selected as the research objects.They were randomly divided into observation group and control group with 45 cases in each group. The control group were given routine laparotomy,while the observation group were given laparoscopic radical gastrectomy. The general operation conditions including intraoperative bleeding volume,operation time, postoperative exhaust time, time to get out of bed and stay in hospital of the two groups were observed and recorded. VAS scores at 6,12, 24 and 48 hours after operation were recorded and compared between the two groups. Immune function indexes such as CD3~+, CD4~+, CD8~+, CD4~+/CD8~+, NK were detected and compared between the two groups. The occurrence of postoperative complications was observed and compared between the two groups. Results The blood volume, operation time, exhaust time, time to get out of bed and stay in hospital of the patients in the observation group were significantly less than those in the control group, and the difference was statistically significant(P<0.05). The VAS scores of the patients in the observation group at 6, 12, 24 and 48 hours after operation were significantly lower than those in the control group, the difference was statistically significant(P<0.05). Although there was no significant difference in the values of CD3~+, CD8~+ between the two groups, but the values of CD4~+,CD4~+/CD8~+, NK in the observation group were significantly better than those in the control group, the difference was statistically significant(P<0.05). There were 1 case of incision infection and 1 case of pulmonary infection in the observation group, 3 cases of incision infection, 2 cases of abdominal infection, 2 cases of urinary tract infection, 1 case of pulmonary infection and 1 case of anastomotic leakage in the control group. The incidence of adverse reactions in the observation group was significantly lower than that in the control group, the difference was statistically significant(P<0.05). Conclusion Laparoscopic radical gastrectomy is effective in the treatment of advanced gastric cancer, it not only has little influence on the immune function of patients, but also can reduce the pain and complications of patients after operation.
Objective To investigate the effect of laparoscopic radical gastrectomy on advanced gastric cancer and related indicators. Methods 90 cases of patients with advanced gastric cancer admitted to our hospital from January 2015 to December 2018 were selected as the research objects.They were randomly divided into observation group and control group with 45 cases in each group. The control group were given routine laparotomy,while the observation group were given laparoscopic radical gastrectomy. The general operation conditions including intraoperative bleeding volume,operation time, postoperative exhaust time, time to get out of bed and stay in hospital of the two groups were observed and recorded. VAS scores at 6,12, 24 and 48 hours after operation were recorded and compared between the two groups. Immune function indexes such as CD3~+, CD4~+, CD8~+, CD4~+/CD8~+, NK were detected and compared between the two groups. The occurrence of postoperative complications was observed and compared between the two groups. Results The blood volume, operation time, exhaust time, time to get out of bed and stay in hospital of the patients in the observation group were significantly less than those in the control group, and the difference was statistically significant(P<0.05). The VAS scores of the patients in the observation group at 6, 12, 24 and 48 hours after operation were significantly lower than those in the control group, the difference was statistically significant(P<0.05). Although there was no significant difference in the values of CD3~+, CD8~+ between the two groups, but the values of CD4~+,CD4~+/CD8~+, NK in the observation group were significantly better than those in the control group, the difference was statistically significant(P<0.05). There were 1 case of incision infection and 1 case of pulmonary infection in the observation group, 3 cases of incision infection, 2 cases of abdominal infection, 2 cases of urinary tract infection, 1 case of pulmonary infection and 1 case of anastomotic leakage in the control group. The incidence of adverse reactions in the observation group was significantly lower than that in the control group, the difference was statistically significant(P<0.05). Conclusion Laparoscopic radical gastrectomy is effective in the treatment of advanced gastric cancer, it not only has little influence on the immune function of patients, but also can reduce the pain and complications of patients after operation.
引文
[1]王进,郭绍春,樊林,等.进展期胃癌腹腔镜辅助与开放D2根治术围手术期临床效果比较[J].现代肿瘤医学,2016,24(7):1080-1082.
[2]汪雪,王梦桥,汪树林.腹腔镜胃癌根治术治疗老年进展期胃癌的临床疗效分析[J].腹腔镜外科杂志,2016,21(10):733-736.
[3] Machairas N, Charalampoudis P, Molmenti EP, et al. The value of staging laparoscopy in gastric cancer[J]. Annals of Gastroenterology, 2017,30(3):287-294.
[4] Irino T, Sano T, Hiki N, et al. Diagnostic staging laparoscopy in gastric cancer:a prospective cohort at a cancer institute in Japan[J]. Surgical Endoscopy, 2017,32(2):1-8.
[5]余强.腹腔镜与开腹胃癌根治术治疗进展期胃癌的疗效对比[J].中国现代普通外科进展,2017,20(10):838.
[6]蔡逊,叶家欣,马丹丹,等.完全腹腔镜与腹腔镜辅助胃癌根治术近期临床疗效的对比研究[J].中国普外基础与临床杂志,2016,23(2):186-191.
[7]马文,韩瑞东,王磊.腹腔镜胃癌根治术98例临床分析[J].安徽卫生职业技术学院学报,2016,15(4):55-56.
[8]马君俊,臧潞,胡伟国,等.全腹腔镜远端胃癌根治术胃空肠非离断式Roux-en-Y吻合51例疗效分析[J].中国实用外科杂志,2016,36(9):965-967.
[9]张珂诚,王鑫鑫,卫勃,等.3D与2D腹腔镜胃癌根治术近期疗效对比研究[J].中国实用外科杂志,2017,37(4):437-439.
[10]孙小飞,何子锐.腹腔镜与开腹根治术对进展期胃癌患者免疫及应激水平的影响[J].海南医学院学报,2016,22(22):2721-2723.
[11]范文华,李大勇,王彦东.腹腔镜辅助胃癌根治手术技术对开展全腹腔镜下胃癌根治术的影响[J].安徽医药,2016,20(3):545-546.
[12]程军,胡晓立,杨潇,等.腹腔镜下胃癌根治术对患者肠道屏障功能及炎性因子的影响[J].疑难病杂志,2016,15(7):698-701.
[13]蒋晖,杜军,顾纪明,等.腹腔镜胃癌根治术与开腹胃癌根治术治疗老年胃癌疗效比较[J].新乡医学院学报,2016,33(9):770-773.
[14]沈乃营,何盟国,王智翔,等.腹腔镜远端胃癌D2根治术在进展期胃癌中的临床应用价值[J].现代肿瘤医学,2016,24(23):13-16.
[2]汪雪,王梦桥,汪树林.腹腔镜胃癌根治术治疗老年进展期胃癌的临床疗效分析[J].腹腔镜外科杂志,2016,21(10):733-736.
[3] Machairas N, Charalampoudis P, Molmenti EP, et al. The value of staging laparoscopy in gastric cancer[J]. Annals of Gastroenterology, 2017,30(3):287-294.
[4] Irino T, Sano T, Hiki N, et al. Diagnostic staging laparoscopy in gastric cancer:a prospective cohort at a cancer institute in Japan[J]. Surgical Endoscopy, 2017,32(2):1-8.
[5]余强.腹腔镜与开腹胃癌根治术治疗进展期胃癌的疗效对比[J].中国现代普通外科进展,2017,20(10):838.
[6]蔡逊,叶家欣,马丹丹,等.完全腹腔镜与腹腔镜辅助胃癌根治术近期临床疗效的对比研究[J].中国普外基础与临床杂志,2016,23(2):186-191.
[7]马文,韩瑞东,王磊.腹腔镜胃癌根治术98例临床分析[J].安徽卫生职业技术学院学报,2016,15(4):55-56.
[8]马君俊,臧潞,胡伟国,等.全腹腔镜远端胃癌根治术胃空肠非离断式Roux-en-Y吻合51例疗效分析[J].中国实用外科杂志,2016,36(9):965-967.
[9]张珂诚,王鑫鑫,卫勃,等.3D与2D腹腔镜胃癌根治术近期疗效对比研究[J].中国实用外科杂志,2017,37(4):437-439.
[10]孙小飞,何子锐.腹腔镜与开腹根治术对进展期胃癌患者免疫及应激水平的影响[J].海南医学院学报,2016,22(22):2721-2723.
[11]范文华,李大勇,王彦东.腹腔镜辅助胃癌根治手术技术对开展全腹腔镜下胃癌根治术的影响[J].安徽医药,2016,20(3):545-546.
[12]程军,胡晓立,杨潇,等.腹腔镜下胃癌根治术对患者肠道屏障功能及炎性因子的影响[J].疑难病杂志,2016,15(7):698-701.
[13]蒋晖,杜军,顾纪明,等.腹腔镜胃癌根治术与开腹胃癌根治术治疗老年胃癌疗效比较[J].新乡医学院学报,2016,33(9):770-773.
[14]沈乃营,何盟国,王智翔,等.腹腔镜远端胃癌D2根治术在进展期胃癌中的临床应用价值[J].现代肿瘤医学,2016,24(23):13-16.