腹腔镜辅助下远端胃癌根治术治疗胃癌的疗效及对血清CRP、CEA水平的影响

Effect of laparoscopic distal gastrectomy on gastric cancer and its influence on CRP and CEA levels

目的探讨腹腔镜辅助下远端胃癌根治术治疗胃癌的疗效及对血清C-反应蛋白（CRP）、癌胚抗原（CEA）水平的影响。 方法选取胃癌患者84例，根据不同手术方式分为两组，每组42例。对照组行传统开腹远端胃癌根治术，观察组行腹腔镜辅助下远端胃癌根治术。对比两组手术时间、术中出血量、淋巴结清扫数目、胃肠道功能恢复时间、止痛剂使用次数、住院时间等一般指标及并发症发生率；并对比手术前后血清炎性因子[CRP、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）]、免疫功能指标[T淋巴细胞亚群CD3＋、CD4＋、CD4＋/CD8＋]及血清CEA水平。 结果①一般情况：两组手术时间及淋巴结清扫数目比较差异未见统计学意义（P〉0.05），观察组术中出血量及术后止痛剂使用次数少于对照组，胃肠道功能恢复时间、住院时间少于对照组，差异有统计学意义（P〈0.05）。②血清炎性因子：术前，两组CRP、IL-6、TNF-α水平比较差异未见统计学意义（P〉0.05）；术后72 h，两组CRP、IL-6、TNF-α均较术前上升，但观察组水平低于对照组，差异有统计学意义（P〈0.05）。③免疫功能：术前，两组CD3＋、CD4＋及CD4＋/CD8＋水平比较差异未见统计学意义（P〉0.05），术后72 h，两组CD3＋、CD4＋及CD4＋/CD8＋均较术前下降，但观察组水平高于对照组，差异有统计学意义（P〈0.05）。④血清CEA：手术前后两组CEA水平组间比较差异未见统计学意义（P〉0.05）；术后7 d，两组CEA水平较术前均明显降低，差异有统计学意义（P〈0.05）。⑤并发症：观察组术后并发症发生率[4.76%（2/42）]低于对照组[19.05%（8/42）]，差异有统计学意义（P〈0.05）。 结论给予胃癌腹腔镜辅助下远端胃癌根治术治疗，临床效果显著，对机体损伤小，有利于减轻术后疼痛，降低血清CEA水平，且对术后机体炎症反应及免疫功能影响相对较小。

ObjectiveTo investigate the effect of laparoscopy assisted distal gastrectomy on gastric cancer and its influence on CRP and CEA levels. MethodsEighty-four gastric cancer patients were divided into control group and observation group according to operation methods, with 42 cases in each group. The patients in the control group were treated with conventional open distal radical gastrectomy, and the patients in the observation group were treated with laparoscopy assisted distal gastrectomy for gastric cancer. The operation time, intraoperative blood loss, lymph node dissection number, gastrointestinal function recovery time, number of analgesic use, hospital stay time and complications incidences were analyzed; the serum inflammatory factors [CRP, interleukin -6 （IL-6）, tumor necrosis factor -α （TNF-α）], immune function indexes [T lymphocyte subsets CD3＋ , CD4＋ , CD4＋ /CD8＋ ] and serum CEA levels were analyzed as well.Results①General situation： there was no significant difference in the operation time or lymph node dissection between the two groups （P〉0.05）, the bleeding amount and postoperative analgesic use were less in the observation group than those in the control group, the gastrointestinal function recovery time and hospital stay time were shorter than those of the control group, the difference wasignificant （P〈0.05）; ②Serum inflammatory factors： there was no significant difference in CRP, IL-6 and TNF-α between the two groups before operation （P〉0.05）, 72 h after operation, the CRP, IL-6 or TNF-α levels in both groups were higher than those before operation, but the observation group was lower than the control group, the difference was significant （P〈0.05）; ③ Immune function： There was no significant difference in CD3 ＋ , CD4 ＋ or CD4 ＋ /CD8 ＋ levels between the two groups before operation （P〉0.05）, 72 h after operation, CD3 ＋ , CD4 ＋ and CD4 ＋ / CD8 ＋ in both groups were lower than those before operation, but the observation group was higher than the control group, the difference was significant （P〈0.05）; ④Serum CEA： There was no significant difference in CEA level between the two groups before and after operation （P〉0.05）, 7 d after operation, CEA levels in both groups were significantly lower than those before surgery, the differences were significant （P〈0.05）; ⑤Complications： The postoperative complications incidence in the observation group was 4.76% （2/42）, which was lower than that in the control group （19.05%, 8/42）, the difference was significant （P〈0.05）. ConclusionsLaparoscopy assisted distal gastrectomy gets significant clinical effect on gastric cancer, which can decrease the damage to the body, reduce the postoperative pain and serum CEA levels, and it has little effect on postoperative inflammatory response and immune function.