腹腔镜与开腹胃大部切除术的前瞻性对比研究

Prospective and comparative study on laparoscopic subtotal gastrectomy and open surgery

目的探讨腹腔镜胃大部切除术的优越性。方法将2001年10月～2003年3月收治的50例胃十二指肠球部溃疡穿孔患者随机分为腹腔镜组和开腹组，各25例，均行胃大部切除术，比较两组的手术时间、术中出血量、术后住院时间、术后肛门排气时间、术后并发症、术前及术后1～3d每天早晨血清胃动素、C-反应蛋白（CRP）、肿瘤坏死因子（TNF）、白细胞介素（IL）-6的表达。结果开腹组术后切口感染5例，腹腔镜组1例，两组比较差异有统计学意义（P〈0．05）。与开腹组比较。除手术时间差异无统计学意义外（P〉0．05），腹腔镜组术后出血量少、术后胃动素高峰值提前及肛门排气时间早、术后并发症少、术后住院时间短（P均〈0．05），两组术后1、3d IL-6、TNF较术前明显升高（P均〈0．01）。结论腹腔镜胃大部切除术是安全可行的，且比开腹胃大部切除术具有优越性。

Objective To analyse the feasible and advantage of laparoscopic subtotal gastrectomy. Methods Fifty cases with gastroduodenal ulcer perforation who underwent laparoscopic subtotal gastrecto- my and open surgery were divided into group A and group B （n = 25）respectively. The operative parameters including operation time,blood loss, postoperative stay in hospital,venting time, complication ,gastric acid secretion （GAS）, C-reactive protein （CRP）, tumor necrosis factor （TNF）and interleukin （IL） -6 were recorded preoperatively and from the first to third days postoperatively. Results Compared with group B, there was no significant difference on the operation time in group A （P〉 0.05）,the blood loss and complication were lesser,the peak of GAS postoperative and venting time were earlier,and the hospital stay was shorter （P 〈 0.05）. TNF and IL-6 were increased postoperative in two groups （P 〈 0.01）. Conclusion Laparoscopic subtotal gastrectomy is feasible and safety, more advantage than open surgery.