87例腹腔镜胃癌手术患者的临床疗效分析

Clinical efficacy analysis of 87 cases of laparoscopic gastric surgery

目的探讨腹腔镜胃癌手术的临床疗效。方法选择胃癌患者87例为研究对象,根据治疗方法不同将患者分为观察组(n=45)与对照组(n=42),观察组患者接受腹腔镜手术治疗,对照组患者接受开腹手术治疗,比较分析两组患者手术前后国际标准化比值(INR)、血清活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、D-二聚体(D-D)、纤维蛋白原(FIB)的变化情况及术前、术后6 h、术后24 h的肿瘤坏死因子-α(TNF-α)、血清白细胞介素-6(IL-6)、血清白细胞介素-8(IL-8)水平变化情况,并根据两组患者的基本情况判定疗效。结果术后,两组患者的INR、APTT及PT值均较本组术前降低,D-D、FIB水平均较本组术前升高,且观察组的INR、APTT及PT值低于对照组(P﹤0.05),D-D、FIB水平高于对照组(P﹤0.05);术后6 h,两组患者血清中的TNF-α、IL-6、IL-8水平均较本组术前升高,术后24 h,各指标水平均逐渐降低,术后6 h、术后24 h观察组的TNF-α、IL-6、IL-8水平均低于对照组(P﹤0.05)。结论腹腔镜手术治疗胃癌的临床疗效显著,术后炎性因子介质的释放有所减少,对机体免疫功能影响小,但对患者的凝血功能影响较大,治疗时应采取相应措施预防凝血功能异常导致的血栓。

To investigate the clinical efficacy of laparoscopic gastric surgery. Methods： From July 2014 to June 2016 patients in our hospital ,87 cases of gastric cancer were selected as the study sample.The observation group which had 45 cases were treated with laparoscopic surgery, the control group which had 42 cases received conventional treatment of abdominal surgery.INR, APTT, PT, D-D, FIB and other coagulation factors were compared between two groups of patients before and after the surgery, the change of TNF-α, IL-6 and IL-8 were compared preoperative and postoperative 6h, 24h ,and determine the efficacy based on the basic situation of the two groups of patients. Results： Postoperative, INR, APTT and PT levels between the two groups were significantly lower, and the observation group was more than the control group, and two groups of patients after D-D and FIB were significantly increased, and the observation group higher in the control group, the difference was statistically significant （P 〈0.05）, after 6h, two groups of patients serum TNF-α, IL-6 and IL-8 levels were significantly increased, and the observation group and postoperative 24h, serum TNF-α, IL-6 and IL-8 levels and decreased in the observation group than the control group, the difference was statistically significant （P 〈0.05）, the observation group in operation time, blood loss the amount of the basic indicators, the length of the wound, the wound length of time should be eating less than the control group, the difference was statistically significant （P 〈0.05）. Conclusion： The clinical efficacy of laparoscopic treatment of gastric cancer significantly, after the release of inflammatory cytokines media has decreased, little effect on immune function, but a greater impact on blood coagulation in patients, treatment should take appropriate measures to prevent coagulation abnormalities cause thrombus.