开腹与腹腔镜远端胃癌D2根治术治疗进展期胃癌的效果及对患者免疫功能和应激反应的影响

Effect analysis and influence on immune function and stress response of laparotomy and laparoscopic D2 radical distal gastrectomy for advanced gastric cancer

目的:探讨开腹与腹腔镜远端胃癌D2根治术治疗进展期胃癌的效果及对患者免疫功能和应激反应的影响。方法:回顾性分析2015年3月~2018年3月在我院接受治疗的87例进展期胃癌患者的临床资料。根据治疗术式的不同分为开腹组(39例,行开腹远端胃癌D2根治术)与腹腔镜组(48例,行腹腔镜远端胃癌D2根治术)。对比两组手术效果、术后恢复情况、术后并发症,并于术前1天及术后第1天、第7天检测应激反应及免疫功能指标的变化。结果:与开腹组比较,腹腔镜组手术时间、手术切口长度、术中出血量均明显减少,但总淋巴结清扫数目无统计学差异。腹腔镜组术后首次肛门排气时间、离床活动时间、术后进流质饮食时间、术后住院时间及并发症总发生率均优于开腹组。与术前相比,两组患者血清CRP、IL-6及NO水平术后第1天达峰值,术后第7天降低;与开腹组术后相比,腹腔镜组术后第1天、第7天血清CRP、IL-6及NO水平较低。术后第1天、第7天,两组患者CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)均较术前降低;与腹腔镜组相比,开腹组术后7天上述指标降低更明显。结论:腹腔镜远端胃癌D2根治术治疗进展期胃癌,具有创伤小,术后并发症少,免疫功能抑制程度低、机体应激反应轻等优点,更利于术后恢复。

Objective To investigate the Effect analysis and influence on stress response and immune function of laparotomy and laparoscopic D2 radical distal gastrectomy for advanced gastric cancer.Methods The clinical data of 87 patients with advanced gastric cancer treated in our hospital from March 2015 to March 2018 were analyzed retrospectively.The patients were divided into laparotomy group(39 patients received open D2 radical distal gastrectomy)and laparoscopy group(48 patients received laparoscopic D2 radical distal gastrectomy)according to the different treatment methods.The operative effects,postoperative recovery and postoperative complications were compared between the two groups.The changes of stress reaction and immune function indexes before operation,1天and 7 d after operation were detected.Results Compared with the patients in laparotomy group,the operation time,incision length,blood loss of the observation group were significantly reduced,while the cleared lymph nodes number between the two groups was no significant difference.The time to first flatus,time to ambulation,time to resumed oral intake,post-operative hospital stay and the total incidence of postoperative complication in laparoscopy group were significantly shorter than those of laparotomy group.The preoperative serum levels of CRP,IL-6 and NO were not significantly different between the two groups.The serum levels of CRP,IL-6,NO at 1天,7 d after operation were significantly higher than those before operation in the two groups,and the level of laparoscopic group was significantly lower than that of the laparotomy group.The level of CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)of the two groups were significantly decreased at 1d and 7d after operation,and the laparotomy group was significantly lower than the laparoscopic group.Conclusion Laparoscopic D2 radical distal gastrectomy for advanced gastric cancer has the advantages of less trauma,fewer postoperative complications,low degree of immunosuppression,light body stress response,and is more conducive to postoperative recovery.