腹腔镜、开腹胃癌根治术对腹腔粘连的影响

Effect of Laparoscopic and Open Radical Gastrectomy on Abdominal Adhesion

目的比较腹腔镜与开腹胃癌根治术术后对腹腔粘连的影响。方法将31例准备行胃癌根治术的患者随机分为腹腔镜组(16例)和开腹组(15例),对比分析两组患者血清中细胞因子IL-6,IL-1及TNF-α在术前1d、术后第1天、术后第3天、术后第7天的水平变化;同时对比分析这3种细胞因子在腹腔引流液中术后第1天、术后第3天、术后第7天的水平变化。结果腹腔镜组患者平均手术耗时为(200.31±42.96)min/例,明显长于开腹组患者(150.57±41.88)min/例。在这一前提下,术前1d,术后第1天、第3天、第7天等统一时间点测得的血清以及腹腔引流液中IL-6,IL-1及TNF-α的含量明显低于开腹手术组患者(P<0.05)。讨论传统的开腹胃癌根治术会导致较高的腹腔内粘连发生率。而腹腔镜胃癌根治术与前者相比,在术后减轻腹腔内粘连方面具有明显优势,在患者的术后预后方面充分体现出"微创"价值。

Objective To compare the effect of laparoscopic and open radical gastrectomy on postoperative peritoneal adhesion. Methods Thirty-one cases of patients with radical resection of gastric cancer were randomly divided into laparoscopic group（ 16 cases） and open group（ 15 cases）. The changes of serum cytokine IL-6,1L-1 and TNF-α of two groups of patients were competed at preoperative 1 day,postoperative 1 day,3 day and 7 day. The changes of the 3 cytokines in the peritoneal drainage solution at postoperative 1 day,3 day and 7 day were also analyzed. Results Pa- tients in the laparoscopic group in the operation time （ 200.31 ± 42.96 ） minutes was significantly longer than the laparot- omy group in operation time{ 150.57 ± 41.88） minutes. Under the premise, the levels of IL-6, IL-I and TNF-α in the se- rum and peritoneal fluid of the uniform time points were significantly lower than that in the laparotomy group at preopera- tive 1 day, postoperative 1 day,3 day and 7 day. The results were statistically significant （ P 〈 0.05 ）. Conclusion The traditional laparotomy gastric cancer radical can lead to a higher incidence of abdominal cavity adhesion. However,com- pared with the tbrmer,laparoscopic gastric cancer radical has obvious advantage in reducing abdominal cavity adhesion of postoperative patients, and gives full expression to the value of ＂ minimally invasive SiS. patientg postoperative progno-sis.