腹腔镜辅助D2根治术对远端进展期胃癌患者胃泌素族指标的影响

Efficacy evaluation of laparoscopic-assisted D2 resection in the treatment of distal advanced gastric cancer

目的探讨腹腔镜辅助D2根治术对远端进展期胃癌患者胃泌素族指标的影响。方法选取本院2012年4月至2013年5月收治的远端进展期胃癌患者30例为研究对象,随机分为对照组和观察组,每组各15例。对照组患者采用常规开腹D2根治术治疗,观察组患者采用腹腔镜辅助D2根治术治疗,观察并记录两组患者手术一般资料(手术时间、术中出血量、淋巴结清扫数量、胃肠功能恢复时间及住院时间),术后7天血液学指标,术前及术后7天胃泌素族指标[全身适应综合征(general adaptation syndrome,GAS)、胆囊收缩素(CCK)及人胃动素(MTL)]及术后并发症发生情况。结果两组患者手术时间及淋巴结清扫数量比较差异均无显著性(P>0.05);观察组患者术中出血量、胃肠功能恢复时间、住院时间均少于对照组(P<0.01)。两组患者白蛋白及白细胞计数比较差异均无显著性(P>0.05);观察组患者前白蛋白、血红蛋白水平均高于对照组,C反应蛋白低于对照组(P<0.05或P<0.01);术前两组患者GAS、MTL、CCK水平比较差异均无显著性(P>0.05);术后7天两组患者GAS、MTL水平均显著低于术前(P<0.05),CCK水平均显著高于术前(P<0.05),但观察组患者GAS、MTL水平均显著高于对照组(P<0.05),CCK水平显著低于对照组(P<0.05)。观察组患者并发症发生率为20.0%(3/15),对照组为33.3%(5/15),两组比较差异无显著性(P>0.05)。结论与常规D2根治术比较,腹腔镜辅助D2根治术治疗远端进展期胃癌的胃泌素族指标及血液学指标波动均相对更小,更能有效缩短手术时间、胃肠功能恢复时间、住院时间,增加淋巴结清扫数量,减少术中出血量,且不会增加术后并发症发生率,安全有效,值得临床推广应用。

ObjectiveTo investigate the inlfuence of laparoscopic-assisted D2 resection on distal advanced gastric cancer patients with gastrin family indexes.Method30 patients with distal advanced gastric cancer who were treated in our hospital from April 2012 to May 2013 were chose for the study and were randomly divided into control group and observation group, 15 cases in each group. Control group were treated with conventional open D2 resection. observation group were treated with laparoscopic-assisted D2 resection, observed and recorded the two groups of general information （operative time, blood loss, number of lymph node dissection, recovery of gastrointestinal function time and hospital stay）, hematological indices after 7 days, 7 days preoperative and postoperative gastrin family indexes [general adaptation syndrome （GAS）, cholecystokinin （CCK） and human motilin （MTL）] and postoperative complications.ResultThe differences of operative time and number of lymph node dissection between the two groups were not signiifcant （P〉0.05）; the blood loss, gastrointestinal function recovery time, hospital stay of patients in the observation group were less than control group （P〈0.01）. The differences of albumin and white blood cell counts between the two groups were not signiifcantly （P〉0.05）; the albumin, hemoglobin levels before surgury of the observation group were higher, the C reactive protein was lower than control group （P〈0.05 orP〈0.01）; the differences of＆amp;nbsp;GAS, MTL, CCK levels before surgery between the two groups were not statistically signiifcant （P〉0.05）;the GAS, MTL after 7 days of the two groups were signiifcantly lower than the preoperative （P〈0.05）, the CCK before surgery were signiifcantly higher （P〈0.05）, but GAS, MTL levels of patients in observation group were signiifcantly higher （P〈0.05）, the CCK level was signiifcantly lower than control group （P〈0.05）. The complication rate of observation group was 20.0% （3/15）, control group was 33.3% （5/15）, the difference was not statistically significant （P〉0.05）.ConclusionCompared with conventional D2 resection, the radical gastrin family indexes and the treatment of hematological distal lfuctuations of advanced gastric cancer of laparoscopic-assisted D2 resection are relatively smaller, it is more effective to shorten the operation time, recovery time of gastrointestinal function, hospital stay time, increase the number of lymph node dissection, reduce blood loss, and will not increase the incidence of postoperative complications, safe and effective, worthy of clinical application.