腹腔镜胃癌根治术治疗进展期远端胃癌的临床研究

Effect of laparoscopic radical gastrectomy on PA,ALB,TLC and HGB levels in patients with advanced gastric cancer

目的探讨腹腔镜辅助胃癌根治术治疗进展期远端胃癌的安全性及对患者手术后血清前白蛋白(PA)、白蛋白(ALB)、总淋巴细胞计数(TLC)及血红蛋白(HGB)的影响。方法选取2012年6月至2015年6月信阳市中心医院收治的120例进展期远端胃癌患者为研究对象,其中60例行腹腔镜辅助胃癌根治术(腹腔镜组),另60例行开腹胃癌根治术(开腹组),观察两组患者的手术时间、术中出血量、住院时间、术后排气时间、术后C反应蛋白(CRP)浓度、术后并发症,以及两组手术前后血清PA、ALB、TLC及HGB的变化。结果腹腔镜组手术用时长于开腹组(P<0.01),术中出血量、切口长度均小于开腹组(P<0.01),两组清扫的淋巴结数目差异无统计学意义(P>0.05);两组住院时间、术后排气时间、术后CRP浓度差异均有统计学意义(P<0.05);腹腔镜组术后并发症发生率低于开腹组(P<0.05);术后两组血清PA、ALB和HGB均较术前有上升(P<0.05),且腹腔镜组改善程度好于开腹组(P<0.05),但两组TCL手术前后无明显变化(P>0.05)。结论腹腔镜辅助胃癌根治术治疗进展期远端胃癌具有创伤小、术中出血量少、术后并发症发生率低等优点,同时对患者营养状况的干扰要少于开腹组,更利于患者的恢复。

Objective To investigate the effect of laparoscopie assisted gastrectomy on the safety of ad- vanced gastric cancer and serum prealbumin （PA） , albumin （ALB） , total lymphocyte count （TLC） and hemo- globin （HGB）. Methods From January 2012 to June 2015, Xinyaug Central Hospital recruited 120 patients with advanced gastric cancer. Sixty patients underwent laparoscopic assisted gastrectomy （the laparoscopic group） and 60 patients underwent gastrectomy （the open group）. The levels of serum PA, ALB, TLC, HGB, operation time, intraoperative blood loss, hospitalization time, postoperative urination time, postoperative C-re- active protein （CRP） concentration, and postoperative complications were observed. Results The time of the laparoscopie group was significantly longer than that of the open group （ P 〈 0.01 ）. The intraoperative blood loss and incision length were lower than those in the open group （P 〈 0. O1 ）. There was no significant difference in the number of lymph nodes removed （ P 〉 O. 05 ）. There were significant differences between the two groups in hospitalization time, postoperative urination time and postoperative CRP concentration （P 〈 0.05）. The inci- dence of postoperative complications in the laparoscopie group was significantly lower than that in the open group （ P 〈 0. 05 ）. The levels of PA, ALB and HGB in the two groups were significantly higher than those in the open group （P 〈 0.05 ）, the difference was not statistically significant （ P 〉 0. 05 ）. The improvement degree of the laparoscopic group was better than that of the open group （ P 〈 0.05 ） , but there was no obvious change in TCL before and after operation between two groups （P 〉 0.05）. Conclusions Laparoscopic assisted gastrectomy has the advantages of low trauma, less intraoperative blood loss and low incidence of postoperative complications of advanced gastric cancer. At the same time, the nutritional status of patients is with less interference than the open group, which is more conducive to patient recovery.