腹腔镜辅助消化道重建对胃癌患者的应用及患者CyclinD1蛋白表达的影响
|
摘要
背景目前我国胃癌(gastric cancer, GC)的发病率较高且呈逐年上升的趋势,且对GC患者最有效的治疗手段就是胃大部切除或者胃全切,那么患者术中就要面临消化道重建的问题.随着腔镜技术的不断发展, GC患者术中使用腔镜技术进行消化道重建已经十分常见.但是对于腔镜辅助消化道重建是否能达到传统消化道重建的疗效,并不十分确切,故针对腔镜辅助消化道重建的疗效做出研究.目的探讨腹腔镜辅助消化道重建对GC患者的应用及患者Cyclin D1蛋白表达的影响.方法选取2015-05/2018-05天津市第五中心医院收治的行择期腹腔镜下全胃切除术的GC患者120例,随机分为两组,各组60例,研究组应用"P"形空肠袢空肠食管Roux-en-Y吻合术进行消化道重建,对照组应用空肠食管Roux-en-Y吻合术治疗.将两组患者手术时间、术中出血量、术后患者营养状况、并发症发生率以及CyclinD1蛋白表达情况进行对比.从而探究腹腔镜辅助消化道重建对GC患者的应用及其临床价值.结果两组患者术中出血量无差异(P>0.05),就手术时间、肠功能恢复时间方面,研究组低于对照组(P <0.05);研究组患者白蛋白、总蛋白、血红蛋白水平皆高于对照组(P<0.05);研究组上腹饱胀的发生率与倾倒综合征发生率较对照组(P<0.05),而腹泻、反流性食管炎、吻合口狭窄、吻合口出血以及肺部感染发生率两组间无明显差异(P>0.05);两组患者术后7 d,检测CyclinD1蛋白表达,所有患者皆为阴性,两组间无明显差异(P>0.05).结论全GC切除术后进行腹腔镜下消化道重建,有利于患者消化功能的恢复,提高患者术后营养水平,且不增加CyclinD1蛋白表达水平,临床上应当进一步推广应用.
BACKGROUND At present, the incidence of gastric cancer(GC) in China is high and has been increasing year by year. Since the most effective treatment for GC patients is partial or total resection of the stomach, GC patients often require reconstruction of the digestive tract during surgery. With the continuous development of endoscopic techniques, it is very common to use gastroscopic techniques for reconstruction of the digestive tract in patients with GC. However, it is not very clear whether laparoscopic assisted digestive tract reconstruction can achieve the same efficacy as traditional digestive tract reconstruction.AIM To investigate the therapeutic efficacy of laparoscopic assisted gastrointestinal reconstruction in GC patients and the effect on the expression of Cyclin D1 protein. METHODS A total of 120 patients with GC who underwent elective laparoscopic total gastrectomy from May 2015 to May 2018 were randomly divided into either a study group or a control group, with 60 cases in each group. The study group underwent "P"-shaped jejunal loop with esophagojejunal Roux-en-Y anastomosis for the reconstruction of the digestive tract, and the control group underwent esophagojejunal Roux-en-Y anastomosis. The operation time, intraoperative blood loss, postoperative patient nutritional status, complication rate, and Cyclin D1 protein expression were compared between the two groups. RESULTS There was no difference in intraoperative blood loss between the two groups(P > 0.05). The operation time and time to recovery of intestinal function were significantly shorter in the study group than in the control group(P < 0.05). Albumin, total protein, and hemoglobin levels in the study group were significantly higher than those of the control group(P < 0.05). The incidence of upper abdominal fullness and dumping syndrome in the study group was significantly lower than that of the control group(P < 0.05), while there was no significant difference in the incidence of diarrhea, reflux esophagitis, anastomotic stenosis, anastomotic bleeding, or pulmonary infection between the two groups(P > 0.05). The expression of Cyclin D1 protein was detected on the 7 th day after operation, and all patients had negative results. There was no significant difference between the two groups(P > 0.05). CONCLUSION Laparoscopic gastrointestinal reconstruction after total GC resection is beneficial to the recovery of digestive function, improve the postoperative nutritional level of patients, and dose not increase the expression level of Cyclin D1 protein.
BACKGROUND At present, the incidence of gastric cancer(GC) in China is high and has been increasing year by year. Since the most effective treatment for GC patients is partial or total resection of the stomach, GC patients often require reconstruction of the digestive tract during surgery. With the continuous development of endoscopic techniques, it is very common to use gastroscopic techniques for reconstruction of the digestive tract in patients with GC. However, it is not very clear whether laparoscopic assisted digestive tract reconstruction can achieve the same efficacy as traditional digestive tract reconstruction.AIM To investigate the therapeutic efficacy of laparoscopic assisted gastrointestinal reconstruction in GC patients and the effect on the expression of Cyclin D1 protein. METHODS A total of 120 patients with GC who underwent elective laparoscopic total gastrectomy from May 2015 to May 2018 were randomly divided into either a study group or a control group, with 60 cases in each group. The study group underwent "P"-shaped jejunal loop with esophagojejunal Roux-en-Y anastomosis for the reconstruction of the digestive tract, and the control group underwent esophagojejunal Roux-en-Y anastomosis. The operation time, intraoperative blood loss, postoperative patient nutritional status, complication rate, and Cyclin D1 protein expression were compared between the two groups. RESULTS There was no difference in intraoperative blood loss between the two groups(P > 0.05). The operation time and time to recovery of intestinal function were significantly shorter in the study group than in the control group(P < 0.05). Albumin, total protein, and hemoglobin levels in the study group were significantly higher than those of the control group(P < 0.05). The incidence of upper abdominal fullness and dumping syndrome in the study group was significantly lower than that of the control group(P < 0.05), while there was no significant difference in the incidence of diarrhea, reflux esophagitis, anastomotic stenosis, anastomotic bleeding, or pulmonary infection between the two groups(P > 0.05). The expression of Cyclin D1 protein was detected on the 7 th day after operation, and all patients had negative results. There was no significant difference between the two groups(P > 0.05). CONCLUSION Laparoscopic gastrointestinal reconstruction after total GC resection is beneficial to the recovery of digestive function, improve the postoperative nutritional level of patients, and dose not increase the expression level of Cyclin D1 protein.
引文
1帅晓明,高金波,刘兴华,张鹏,白洁,蔡开琳,王国斌,陶凯雄.新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的疗效分析.中华消化外科杂志2016;15:241-246[DOI:10.3760/cma.j.issn.1673-9752.2016.03.007]
2徐卫国,徐华,马君俊,臧潞,薛佩,董锋,陆爱国,王明亮,李健文.腹腔镜辅助胃癌根治术后并发症的Clavien-Dindo分级及危险因素分析.中华消化外科杂志2016;15:228-233[DOI:10.3760/cma.j.issn.1673-9752.2016.03.005]
3 Chen XJ,Chen YZ,Chen DW,Chen YL,Xiang J,Lin YJ,Chen S,Peng JS.The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy:A Systemic Review and Meta-Analysis.J Cancer 2019;10:789-798[PMID:30854084DOI:10.7150/jca.28843]
4 Jian-Hui C,Iskandar EA,Cai ShI,Chen CQ,Wu H,Xu JB,He YL.Significance of Onodera’s prognostic nutritional index in patients with colorectal cancer:a large cohort study in a single Chinese institution.Tumour Biol 2016;37:3277-3283[PMID:26438061 DOI:10.1007/s13277-015-4008-8]
5杨金虎.完全腹腔镜下远端胃癌根治术中的消化道重建方式.江苏医药2017;43:215-217[DOI:10.19460/j.cnki.0253-3685.2017.03.022]
6 Tran TB,Worhunsky DJ,Squires MH,Jin LX,Spolverato G,Votanopoulos KI,Cho CS,Weber SM,Schmidt C,Levine EA,Bloomston M,Fields RC,Pawlik TM,Maithel SK,Norton JA,Poultsides GA.To Roux or not to Roux:a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer.Gastric Cancer 2016;19:994-1001[PMID:26400843 DOI:10.1007/s10120-015-0547-3]
7冯兴宇,杨力,朱甲明.全腹腔镜远端胃癌根治术非离断式Roux-en-Y吻合与传统吻合疗效对照多中心研究.中国实用外科杂志2016;36:961-964
8苗儒林,李子禹,王胤奎.腹腔镜全胃切除术消化道重建吻合器选择回顾性对照研究.中国实用外科杂志2016;36:968-972
9朱甲明,臧卫东,臧潞,李勇.非离断Roux-en-Y吻合在全腹腔镜下远端胃癌根治术消化道重建中应用的多中心数据回顾分析.中华胃肠外科杂志2016;19:902-906[DOI:10.3760/cma.j.issn.1671-0274.2016.08.021]
10田贵,孙作成,宋延强.胃癌根治切除联合Roux-en-Y消化道重建对合并2型糖尿病患者糖代谢的影响.中华普通外科杂志2017;32:317-319[DOI:10.3760/cma.j.issn.1007-631X.2017.04.010]
11王博,杨继武,臧潞.完全腹腔镜下远端胃癌根治术胃空肠非离断式Roux-en-Y吻合.中华胃肠外科杂志2015;2:181-182[DOI:10.3760/cma.j.issn.1671-0274.2015.02.019]
12黄玉琴,史友权,汤东,王杰,王道荣.非离断式Roux-en-Y吻合术在远端胃癌根治术后消化道重建的应用进展.中华消化外科杂志2016;15:943-946[DOI:10.3760/cma.j.issn.1673-9752.2016.09.019]
13金希彪,杨永志,杨水仙,郑志强.不同消化道重建术式对胃癌合并2型糖尿病患者术后糖代谢的影响.中国普通外科杂志2016;25:151-154[DOI:10.3978/j.issn.1005-6947.2016.01.024]
14 Kim DJ,Kim W.Lower Esophageal Sphincter-preserving Anastomosis Is an Acceptable Reconstruction Method Following Laparoscopy-assisted Proximal Gastrectomy.Anticancer Res 2019;39:425-430[PMID:30591490 DOI:10.21873/anticanres.13129]
15 Korivi BR,Faria S,Aly A,Sun J,Patnana M,Jensen CT,Wagner-Bartak N,Bhosale PR.Intestinal and diffuse gastric cancer:a retrospective study comparing primary sites.Clin Imaging 2019;56:33-40[PMID:30870726 DOI:10.1016/j.clinimag.2019.03.002]
2徐卫国,徐华,马君俊,臧潞,薛佩,董锋,陆爱国,王明亮,李健文.腹腔镜辅助胃癌根治术后并发症的Clavien-Dindo分级及危险因素分析.中华消化外科杂志2016;15:228-233[DOI:10.3760/cma.j.issn.1673-9752.2016.03.005]
3 Chen XJ,Chen YZ,Chen DW,Chen YL,Xiang J,Lin YJ,Chen S,Peng JS.The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy:A Systemic Review and Meta-Analysis.J Cancer 2019;10:789-798[PMID:30854084DOI:10.7150/jca.28843]
4 Jian-Hui C,Iskandar EA,Cai ShI,Chen CQ,Wu H,Xu JB,He YL.Significance of Onodera’s prognostic nutritional index in patients with colorectal cancer:a large cohort study in a single Chinese institution.Tumour Biol 2016;37:3277-3283[PMID:26438061 DOI:10.1007/s13277-015-4008-8]
5杨金虎.完全腹腔镜下远端胃癌根治术中的消化道重建方式.江苏医药2017;43:215-217[DOI:10.19460/j.cnki.0253-3685.2017.03.022]
6 Tran TB,Worhunsky DJ,Squires MH,Jin LX,Spolverato G,Votanopoulos KI,Cho CS,Weber SM,Schmidt C,Levine EA,Bloomston M,Fields RC,Pawlik TM,Maithel SK,Norton JA,Poultsides GA.To Roux or not to Roux:a comparison between Roux-en-Y and Billroth II reconstruction following partial gastrectomy for gastric cancer.Gastric Cancer 2016;19:994-1001[PMID:26400843 DOI:10.1007/s10120-015-0547-3]
7冯兴宇,杨力,朱甲明.全腹腔镜远端胃癌根治术非离断式Roux-en-Y吻合与传统吻合疗效对照多中心研究.中国实用外科杂志2016;36:961-964
8苗儒林,李子禹,王胤奎.腹腔镜全胃切除术消化道重建吻合器选择回顾性对照研究.中国实用外科杂志2016;36:968-972
9朱甲明,臧卫东,臧潞,李勇.非离断Roux-en-Y吻合在全腹腔镜下远端胃癌根治术消化道重建中应用的多中心数据回顾分析.中华胃肠外科杂志2016;19:902-906[DOI:10.3760/cma.j.issn.1671-0274.2016.08.021]
10田贵,孙作成,宋延强.胃癌根治切除联合Roux-en-Y消化道重建对合并2型糖尿病患者糖代谢的影响.中华普通外科杂志2017;32:317-319[DOI:10.3760/cma.j.issn.1007-631X.2017.04.010]
11王博,杨继武,臧潞.完全腹腔镜下远端胃癌根治术胃空肠非离断式Roux-en-Y吻合.中华胃肠外科杂志2015;2:181-182[DOI:10.3760/cma.j.issn.1671-0274.2015.02.019]
12黄玉琴,史友权,汤东,王杰,王道荣.非离断式Roux-en-Y吻合术在远端胃癌根治术后消化道重建的应用进展.中华消化外科杂志2016;15:943-946[DOI:10.3760/cma.j.issn.1673-9752.2016.09.019]
13金希彪,杨永志,杨水仙,郑志强.不同消化道重建术式对胃癌合并2型糖尿病患者术后糖代谢的影响.中国普通外科杂志2016;25:151-154[DOI:10.3978/j.issn.1005-6947.2016.01.024]
14 Kim DJ,Kim W.Lower Esophageal Sphincter-preserving Anastomosis Is an Acceptable Reconstruction Method Following Laparoscopy-assisted Proximal Gastrectomy.Anticancer Res 2019;39:425-430[PMID:30591490 DOI:10.21873/anticanres.13129]
15 Korivi BR,Faria S,Aly A,Sun J,Patnana M,Jensen CT,Wagner-Bartak N,Bhosale PR.Intestinal and diffuse gastric cancer:a retrospective study comparing primary sites.Clin Imaging 2019;56:33-40[PMID:30870726 DOI:10.1016/j.clinimag.2019.03.002]