腹腔镜辅助下食管癌根治术对患者恢复情况及凝血功能的影响

Effects of laparoscopic-assisted radical resection of esophageal carcinoma on postoperative recovery and blood coagulation

目的分析腹腔镜辅助下食管癌根治术对患者恢复情况及凝血功能的影响。方法行食管癌根治术的患者66例,按手术方式分为腹腔镜组与开放组,其中32例在腹腔镜辅助下行开胸治疗,34例行常规手术治疗,分别比较两组患者手术时间、术中失血量、术后首次排气时间、术后平均住院时间、淋巴结清扫总数及术后并发症情况;并统计分析两组患者术前、术后6小时、术后24小时两组患者血清的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)、D二聚体(D-D)水平。结果腹腔镜组手术时间长于开放组,但开放组术中失血量、术后首次排气时间及术后平均住院时间方面均多于或长于腹腔镜组(P<0.01),两组淋巴结清扫总数比较差异无统计学意义(P>0.05)。术后两组患者APTT、PT水平较术前明显降低,且腹腔镜组降低程度明显大于开腹组(P<0.05);两组患者术后FIB、D—D水平较术前明显升高(P<0.05),且腹腔镜组升高程度明显大于开腹组(P<0.05)。结论腹腔镜辅助下食管癌根治术具有创伤小、恢复快、术后机体应激反应程度轻等优点,但其对患者的凝血功能影响更大,应在围手术期采取相应的预防措施。

Objective To analyze the effects of laparoscopic-assisted radical resection of esophageal carcinoma on postoperative recovery and blood coagulation. Methods A total of 66 patients received radical resection of esophageal carcinoma, including 32 cases with laparoscopic-assisted surgery （laparoscopic group）and 34 cases with regular open surgery （open group ）. The operation time, intraoperative blood loss, postoperative exhaust time, mean postoperative hospital stay, the total number of lymph node, and postoperative complications were analyzed and evaluated in two groups. Also, the activated partial thromboplastin time （ APTT）, prothrombin time （ PT）, fibrinogen （ FIB ）, and D-dimer （ D-D ） levels were analyzed at the preoperative period and 6h and 24h after the surgery in two groups. Results The operation time in the laparoscopic group was longer than the open group, but in the aspects of the blood loss, the operation time, postoperative exhaust time, and mean postoperative hospital stay, the open group was superior to the laparoscopic group（ P 〈 0.01 ）. There was no difference between two groups in the total number of lymph node（ P 〉 0.05 ）. The postoperative APTT and PT were significantly lower in the two groups, and the decline extent of the laparoscopic group was significantly greater than the open group （ P 〈 0.05 ）. Compared with preoperative period, the FIB and D-D levels are significantly increased in the two groups （P 〈 0.05 ）, and the increase of the laparoscopic group was significantly greater than the open group （P 〈 0.05 ）. Conclusion The laparoscopic-assisted radical resection of esophageal carcinoma has advantages in small trauma, quick recovery and low degrees of stress reaction. However, it has great influence on patient＇s blood coagulation and preventive measures should be taken during the perioperative period.