腹腔镜微创对胃癌患者免疫功能影响及临床治疗效果分析

Effect of laparoscopic minimally invasive surgery on immune function in patients with gastric cancer and its clinical efficacy

目的 分析腹腔镜微创对胃癌患者免疫功能影响及临床治疗效果.方法 回顾性选取2012年2月至2017年2月我院收治的手术治疗的胃癌患者80例,根据手术方法不同分为开腹组和腔镜组.开腹组患者采用开腹胃癌根治术治疗,腔镜组患者采用腹腔镜胃癌根治术治疗.观察两组患者手术及术后情况、并发症情况和治疗前后免疫指标水平和胃肠激素水平变化情况.结果 腔镜组患者手术时间长于开腹组[（198.64 ± 43.89）min 与（152.01 ± 42.11）min],切口大小[（5.79 ± 1.54）cm 与（15.96±1.55）cm]、失血量[（75.20±11.36）ml与（129.21±12.03）ml]及住院时间[（8.12±1.58）d与（12.33±1.85）d]均少于开腹组（t值分别为4.849、29.428、20.645、10.944;P均〈0.05）.两组患者淋巴结清扫数量比较差异无统计学意义（P〉0.05）.开腹组患者治疗3 d后CD3＋[（51.90±3.66）%与（62.01 ±3.02）%、CD4＋[（30.25± 3.98）%与（41.13 ± 4.79）%]、CD8＋[（23.01 ± 4.02）%与（28.20 ± 4.15）%]及CD4＋/CD8＋[（0.93±0.21）%与（1.19±0.20）%]水平均低于腔镜组治疗后（t值分别为13.475、11.049、5.681、5.670;P均〈0.05）.腔镜组患者治疗前后免疫指标水平比较差异均无统计学意义（P均〉0.05）.开腹组患者治疗3d后VIP高于治疗前和腔镜组治疗后,MTL和SS低于治疗前和腔镜组治疗后（t值分别为1.707、2.713、4.409、1.756、2.488、3.969;P均〈0.05）.腔镜组患者治疗前后胃肠激素水平比较差异均无统计学意义（P均〉0.05）.腔镜组患者并发症率为10.00%,开腹组为27.50%,腔镜组患者并发症率低于开腹组（χ2=4.021;P〈0.05）.结论 腹腔镜胃癌根治术具有创伤小、出血量少、并发症少的特点,同时对机体免疫功能和胃肠激素影响小,有利于患者术后的恢复.

Objective To analyze the effect of laparoscopic minimally invasive surgery on the immune function of patients with gastric cancer and its clinical efficacy.Methods A total of eighty patients with gastric cancer treated in the First Affiliated Hospital of Hainan Medical University from February 2012 to February 2017 were retrospectively selected.According to the different surgical methods the patients were divided into laparoscopic group and laparotomy group.The laparotomy group was treated with open radical gastrectomy,and the laparoscopic group was treated with laparoscopic radical gastrectomy.The operation and postoperative condition,complications,immune indexes and changes of gastrointestinal hormone levels in the two groups were observed.Results The operation time of the endoscopic group was（198.64±43.89）min,longer than that in the laparotomy group（（152.01 ± 42.11）min）,the incision size（（5.79 ± 1.54）cm）,blood loss（（75.20 ±11.36）ml）and hospitalization time（（8.12±1.58）d）were less than those in the control group（（15.96 ±1.55）cm,（129.21±12.03）ml,（12.33±1.85）d）（t=4.849,29.428,20.645,10.944; P〈0.05）.There was no significant difference in the number of lymph node dissection between the two groups（P〉0.05）.The CD3,CD4,CD8 and CD4 /CD8 in the laparotomy group three days after the treatment were lower than those after treatment in the endoscopic group（（51.90 ± 3.66）% vs.（62.01 ± 3.02）%;（30.25 ± 3.98）% vs.（41.13 ±4.79）%;（23.01±4.02）% vs.（28.20 ± 4.15）%;（0.93 ± 0.21）% vs.（1.19 ± 0.20）%）（t=13.475, 11.049,5.681,5.670,P〈0.05）.No significant difference was showed between the levels of immune indexes before and after treatment in the endoscopic group（P〉0.05）.The VIP in the laparotomy group 3d after the treatment was higher than those before treatment and in the laparoscopic group after treatment,MTL and SS were lower than those before treatment and in the endoscopic group after treatment（t=1.707,2.713,4.409,1.756, 2.488,3.969;P〈0.05）.There was no significant difference in the levels of gastrointestinal hormones before and after treatment in the endoscopic group（P〉0.05）.The complication rate in the endoscopic group was 10% and 27.50% in the laparotomy group,and the complication rate in the endoscopic group was lower than that in the laparotomy group（χ2=4.021;P〈0.05）.Conclusion Laparoscopic radical gastrectomy has the advantages of less trauma,less bleeding loss and less complications.It also has little effect on the immune function and gastrointestinal hormones,which is beneficial to the recovery of postoperative patients.