腹腔镜与开腹远端胃癌根治术的临床疗效对比及凝血功能变化分析

Clinical effect and coagulation function changes of laparoscopic and open radical resection in distal gastric cancer patients

目的:对比腹腔镜与开腹远端胃癌根治术对远端胃癌患者的临床疗效。方法:将80例胃癌患者分为腹腔镜组和开腹组各40例,比较2组患者手术一般情况、术后恢复情况、T淋巴细胞亚群活性、N K细胞活性;并对2组患者术后凝血功能变化情况进行分析。结果:腹腔镜组手术时间明显高于开腹组,术中出血量、清除淋巴结数量显著低于开腹组,而肛门排气、排便以及下床活动时间均早于开腹组,2组相比差异具有统计学意义(P<0.05);腹腔镜组C D 3+、C D 4+、C D 8+、C D 4+/C D 8+、N K细胞活性显著高于开腹组(P<0.05)。2组患者术后活化部分凝血活酶时间(A PTT)、国际标准化比值(IN R)与术前相比差异无统计学意义(P>0.05),而术后24 h 2组患者凝血酶原时间(PT)均显著缩短(P<0.05)。手术结束时腹腔镜组患者血浆纤维蛋白原(FIB)、D-二聚体显著升高,术后24 h 2组患者FIB、D-二聚体均继续升高,与术前相比差异均有统计学意义(P<0.05);其中开腹组手术结束时及术后24 h FIB、D-二聚体显著低于腹腔镜组(P<0.05)。结论:腹腔镜胃癌根治术可以取得与开腹手术相当的近期疗效,但是术后血栓形成的风险更高,临床上需要在围手术期采取积极的预防措施。

Objective： To compare the clinical curative effect and the coagulation function changes of laparoscopic and open distal gastrectomy in patients with distal gastric cancer. Methods： 80 cases of gastric cancer patients were divided into laparoscopic group and laparotomy groupevery 40 cases, compared two groups of patients with operation in general, postoperative recovery, Tlymphocyte subsets, NK cell activity;and analysised the changes in coagulation function after operation in the two group patients. Results： Operation time of laparoscopic group was significantly higher than that of the open group, intraoperative blood loss, number of lymph node dissection was significantly lower than that of the open group, and anal exhaust, defecate and ambulation time was earlier than the open group, the difference was statistically significant when compared between the two groups（P〈0.05）;The laparoscopic group CD3^＋, CD4^＋, CD8^＋, CD4^＋/CD8^＋, NK cell activity was significantly higher than that in the open group（P〈0.05）.After operation two groups of patients after APTT,INR compared with those before operation had no significant difference（P〉0.05）, and postoperative24 h PT in the two groups were shortened significantly（P〈0.05）. At the end of operation in the laparoscopic group FIB, two D-dimer was significantly elevated after operation in two groups; 24h FIB, two D-dimer were to continue to rise, compared with the preoperative differences were statistically significant（P〈0.05）; the open group at the end of operation and postoperative 24 h FIB was significantly lower than the laparoscopic group, postoperative 24 h the two D-dimer is significantly lower than the laparoscopic group（P〈0.05）. Conclusion： Laparoscopic and open gastrectomy for gastric cancer had same efficacy,but the risk of thrombosis after operation is more high, the clinical need take active preventive measures in the peri operation period.