腹腔镜胃癌根治术对术后胃肠动力恢复及胃肠激素的影响研究

Effect of Laparoscopic Radical Gastrectomy on Gastrointestinal Motility and Gastrointestinal Hormones in Patients with Gastric Cancer

目的探讨腹腔镜胃癌根治术对术后胃肠动力恢复及胃肠激素的影响。方法选取2013年12月至2015年12月期间我科对289例行腹腔镜胃癌根治术的患者作为观察组,选取同期325例行传统开腹胃癌根治术的患者作为对照组,分析比较2组患者术后肠鸣音恢复时间、首次肛门排气时间及术前12 h、术后24 h时血液中胃泌素、胃动素、血管活性肠肽水平。结果 2组患者的基线资料比较差异无统计学意义(P>0.05)。观察组术后肠鸣音恢复时间及首次肛门排气时间较对照组明显缩短(P<0.05)。2组术后24 h时血液中胃泌素和胃动素水平均较术前12 h时明显下降(P<0.05),而2组术后24 h时血液中血管活性肠肽水平均较术前明显上升(P<0.05);观察组术后24 h时血液中胃泌素和胃动素水平均明显高于对照组,而观察组术后24 h时血液中血管活性肠肽水平明显低于对照组(P<0.05)。结论腹腔镜胃癌根治术后患者胃肠道动力恢复明显快于开腹胃癌根治术,术后血液中胃泌素、胃动素及血管活性肠肽改变亦与手术方式有关,其可能是腹腔镜胃癌手术后胃肠动力恢复更快的机制之一。

Objective To investigate effect of laparoscopic radical gastrectomy on gastrointestinal motility and gastrointestinal hormones in patients with gastric cancer. Methods Two hundred and eighty-nine patients who underwent laparoscopic radical gastrectomy from December 2013 to December 2015 were selected as observation group, 325 patients underwent laparotomy radical gastrectomy during the same period were selected as control group. The postoperative bowel sounds recovery time, the first anal exhaust time, and gastrin, motilin and vasoactive intestinal peptide levels in blood at 12 h before operation and at 24 h after operation were compared between these two groups. Results The baselines had no significant differences between these two groups （P〉0.05）. The postoperative bowel sounds recovery time and the first anal exhaust time in the observation group were significantly shorter than those in the control group （P〈0.05）. Compared with the levels at 12 h before operation, the gastrin and motilin levels were significantly decreased and the vasoactive intestinal peptide level was significantly increased at 24 h after operation in these two groups （P〈0.05）; Compared with the control group, the gastrin and motilin levels at 24 h after operation were significantly increased （P〈0.05） and the vasoactive intestinal peptide level was significantly decreased in the observation group （P〈0.05）. Conclusions Postoperative gastrointestinal motility recovery time in patients undergoing laparoscopic radical gastrectomy is significantly faster than that of laparotomy radical gastrectomy. There is a certain relation between gastrin, motilin or vasoactive intestinal peptide change and operation mode, it might be one of mechanisms of faster recovery of gastrointestinal motility after laparoscopic radical gastrectomy for gastric cancer.