腹腔镜下胃癌根治术对患者肠道屏障功能及炎性因子的影响

The effect of intestinal barrier function and inflammatory cytokines after laparoscopic gastrectomy

目的研究腹腔镜下胃癌根治术对患者肠道屏障功能及炎性因子的影响。方法 2013年5月—2014年5月潜江市中心医院普外科收治胃癌患者66例,按照随机数字表法分为腹腔镜下胃癌根治术33例(观察组)和开腹根治术33例(对照组),观察2组患者的手术情况,比较2组患者手术前后血浆二胺氧化酶、D-乳酸、C-反应蛋白(CRP)及炎性因子水平。结果观察组切口长度、出血量、恢复肠道功能所需时间、住院时间均显著优于对照组[分别为(6.23±0.87)cm、(125.35±15.21)ml、(3.02±0.58)d、(8.93±1.79)d和(14.69±2.02)cm、(293.24±18.29)ml、(4.87±1.01)d、(15.02±3.11)d],差异具有统计学意义(t=22.097、40.544、9.125、9.750,P<0.05);术前1d,2组患者的D-乳酸、二胺氧化酶、CRP水平无明显差异(P>0.05);术后第1d、5 d、7 d、10 d,2组患者的D-乳酸、二胺氧化酶、CRP水平与术前1 d比较均表现为不同程度的下降趋势(P<0.01);且观察组患者术后各时段D-乳酸、二胺氧化酶、CRP浓度显著低于对照组,差异具有统计学意义(P<0.05)。术后12h,观察组的IL-6、IL-8、TNF-α水平明显低于对照组[(21.32±2.02)ng/L、(17.87±2.43)ng/L、(124.57±10.32)pg/ml vs.(30.32±2.54)ng/L、(25.32±3.21)ng/L、(153.26±13.25)pg/ml,t=15.931、10.630、9.813,P<0.05]。结论腹腔镜下胃癌根治术对肠道屏障功能和机体应激反应的影响较小,有利于患者术后在较短时间内得以恢复,值得在临床展开推广。

Objective To study the effect of laparoscopic radical gastrectomy on intestinal barrier function and inflammatory factors in patients with gastric cancer.Methods Sixty-six cases of gastric cancer patients from May 2013 to May2014 in Department of general surgery,Qianjiang Central Hospital were enrolled.According to random number table method,they were divided into the following group,the laparoscopic gastrectomy of 33 patients as the observation group,open radical surgery of 33 patients as the control group.Surgery situation of two groups patients were observed,plasma lactate concentrations,D dioxide enzymes,C reactive protein levels（CRP）,and inflammatory in different time were compared.Results The incision length were（6.23 ±0.87） cm,the amount of bleeding were（125.35 ± 15.21） ml,the time required for the recovery of intestinal function were（3.02 ±0.58） d,and length of hospital stay were（8.93 ±1.79） d of the observation group,which were significantly better than the control group＇ s（14.69 ± 2.02） cm,（293.24 ± 18.29） ml,（4.87 ± 1.01） d,（15.02±3.11） d,the difference were statistically significant（t =22.097,t =40.544,t =9.125,t =9.750,P 0.05）.Preoperative 1 d,2 groups of patients＇ D lactic acid,diamine oxidase,CRP levels had no obvious difference（P 0.05）.Postoperative 1 d,5 d,7 d,10 d,patients＇ D lactic acid,diamine oxidase,CRP levels compared with preoperative 1 d were characterized by different degrees of decline（P 0.01）.In each period,the observation group of patients＇ postoperative D lactic acid concentration was significandy lower than the control group;the differences were statistically significant（P 0.05）.12 h after surgery,observation group＇s IL-6,IL-8,TNF-α level significantly lower than the control group[（21.32 ±2.02） ng/L,（17.87±2.43） ng/L,（124.57 ± 10.32） pg/ml vs.（30.32±2.54） ng/L,（25.32 ±3.21） ng/L,（153.26±13.25） pg/ml）]（t =15.931,t =10.630,t =9.813,P 0.05）.Conclusion Laparoscopic gastrectomy is a relatively safe and effective procedure,the intestinal barrier function and body＇s stress response have little effect,which can be more beneficial to patients in a short time to recover,it is worth in clinical application.