腹腔镜胃癌根治术与开腹胃癌根治术安全性的比较

Comparison on Safety Between Radical Gastrectomy with Laparoscope and Laparotomy

目的比较腹腔镜胃癌根治术与开腹手术方式在治疗胃癌中的安全性。方法回顾性选取胃癌患者80例,按手术方式分为腹腔镜组(50例)和开腹组(30例)。80例患者均在术前1天抽血查血清皮质醇(Cor)、去甲肾上腺素(NE)、总抗氧化能力(TAC)、过氧化氢酶(CAT)的水平。腹腔镜组按经典5孔法腹腔镜胃癌D2根治术进行手术;开腹组按传统开腹D2根治术。分别于术后4周、8周监测Cor、NE、TAC、CAT水平,比较两种手术方式之间各指标的差异。结果腹腔镜手术切口长度、术中出血量、术后恢复进程等方面与开腹组比较具有明显优势(P<0.05)。术后4周、8周时两组Cor、NE、TAC、CAT水平差异具有统计学意义(P<0.05)。结论两种手术方式治疗胃癌均可达到良好的治疗效果,腹腔镜手术治疗胃癌的创伤小、术中出血少、术后并发症少且术后恢复快,安全性高,可以推广。

Objective To compare the safety between radical gastrectomy with Laparoscope and laparotomy. Methods 80 patients with gastric cancer treated in two hospitals （ the Second Affiliated Hospital of University of South China and Affiliated NanHua Hospital of University of South China） from April 2012 to March 2014 were spicilegiumed as objects of study. They were divided in to laparoscopy group（ 50 cases of group A） and laparotomy group （30cases of group B） according to surgical method. Laparoscopy group was operated with classical laparoscope, the other one with laparotomy. Test the level of serum cortisol （Car） , Norepinephrine （ NE ） , total antioxidant capacity （ TAC ） , catalase （CAT） 1 day before operation and 4W,8W after operation. Results were analyzed with statistics, to contrast that they have or not have statistic difference between two groups. Result Compared with laparotomy group, laparoscopy group was better in incision length, blood loss, postoperative recovery processes, etc. The difference was statistically significant （ P 〈 0.05 ）. There is no difference between two groups on the level of Cor, NE, TAC, CAT before operation （P 〉 0.05 ）. The level of Cot, NE, TAC, CAT 4W,SW after surgical treatment has significant difference （ P 〈 0.05 ）. Conclusion Two methods can gain good clinical effect in early treatment. But compared with traditional laparotomy of gastric cancer, laparoscopie dissection has smaller wound ,less blood loss ,fewer complications ,faster recovery and higher safety. It should be generalized.