单孔加一孔腹腔镜对胃癌根治术患者应激反应及术后恢复的影响

Stress response and postoperative recovery of patients undergoing radical resection of gastric cancer by single-port plus single-incision laparoscopic surgery

目的探讨单孔加一孔腹腔镜(SILS+1)与传统五孔腹腔镜对胃癌根治术患者应激反应及术后恢复的影响。方法将130例行腹腔镜胃癌根治术患者按手术方式不同分为SILS+1组(n=72)和传统腹腔镜组(n=58)。对比两组患者围手术期指标、血流动力学指标[收缩压(SBP)、舒张压(DBP)、心率(HR)、平均动脉压(MAP)]及应激反应指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)]的差异。结果与传统腹腔镜组相比,SILS+1组患者手术时间明显更长,术中补液量明显更多,切口长度明显更小,术中出血量明显更少,差异均有统计学意义(P﹤0.01)。SILS+1组患者术后胃管拔除时间、首次进食时间、首次通气时间、首次排便时间、首次下床活动时间、住院时间均短于传统腹腔镜组,差异均有统计学意义(P﹤0.05)。气腹后30 min、气腹后60 min、气腹结束后30 min时,SILS+1组患者SBP、DBP、HR、MAP水平均低于传统腹腔镜组,差异均有统计学意义(P﹤0.05)。术后1天,两组患者血清CRP、IL-6、PCT水平均上升,且SILS+1组患者血清CRP、IL-6、PCT水平均低于传统腹腔镜组,差异均有统计学意义(P﹤0.05)。结论与传统五孔腹腔镜手术相比,尽管SILS+1增加手术时间,但具有更好短期临床疗效,更能改善胃癌根治术患者血流动力学情况,更有利于促进患者术后恢复,降低患者应激反应水平。

Objective To investigate the effect of single-port plus single-incision laparoscopic surgery(SILS+1)and traditional five-port laparoscopy on stress response and postoperative recovery in patients undergoing radical resection of gastric cancer.Method A total of 130 patients undergoing laparoscopic radical resection of gastric cancer were divided into the SILS+1 group(n=72)and traditional laparoscopy group(n=58).The perioperative indexes,hemodynamics indexes[systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),mean arterial pressure(MAP)]and stress response indexes[serum C-reactive protein(CRP),interleukin-6(IL-6),procalcitonin(PCT)]were compared between the two groups.Result The operation time and intraoperative fluid replacement were higher,the incision length and intraoperative bleeding lower in the SILS+1 group than those in the traditional laparoscopy group(P<0.05).The time of gastric tube extubation,first feeding,first ventilation,first defecation,first ambulation and hospitalization in SILS+1 group were significantly shorter than those in traditional laparoscopy group(P<0.05).The levels of SBP,DBP,HR and MAP in SILS+1 group were significantly lower than those in traditional laparoscopy group 30 min after pneumoperitoneum,60 min after pneumoperitoneum and 30 min after end of pneumoperitoneum(P<0.05).The serum levels of CRP,IL-6 and PCT in both groups increased 1 day after operation with lower levels in the SILS+1 group than those in traditional laparoscopy group(P<0.05).Conclusion Compared with the traditional five-port laparoscopic surgery,although the operation time is increased,SILS+1 has a better short-term clinical effect,and improve the hemodynamics,promote postoperative recovery and reduce the level of stress response of patients undergoing radical resection of gastric cancer.