ERAS下腹腔镜胃癌D2根治术联合胃完整系膜切除术治疗进展期胃癌的临床研究

Clinical study of ERAS laparoscopic D2 radical gastrectomy combined with intact mesangial gastrectomy in the treatment of advanced gastric cancer

目的研究加速康复外科(ERAS)下腹腔镜胃癌D2根治术联合胃完整系膜切除术(EME)治疗进展期胃癌患者的临床效果。方法选择2018年3月至2020年3月138例进展期胃癌患者进行研究,根据围术期不同处理方法按随机数字表法分为ERAS组69例(围术期采用ERAS),对照组69例(传统方案)。两组患者均行腹腔镜胃癌D2根治术联合胃完整系膜切除术。应用SPSS20.0软件进行数据处理,术中术后各项指标和免疫指标等计量资料采用(x±s)表示,独立样本t检验;术后并发症组间比较采用χ^(2)检验,以P<0.05为差异有统计学意义。结果ERAS组术后排气时间、下床活动时间、住院时间均显著少于对照组(P<0.05)。ERAS组术后并发症总发生率4.3%显著低于对照组18.8%(P<0.05);两组患者术后1 d血液中CD3^(+)、CD4^(+)/CD8^(+)均呈现下降趋势,CD8^(+)呈上升趋势,ERAS组术后1 d、3 d、7 d血液中CD3^(+)、CD8^(+)、CD4^(+)/CD8^(+)优于对照组(P<0.05);术后1 d、3 d、7 d ERAS组血液中TNF-α、IL-6、CRP及WBC水平均显著低于对照组(P<0.05)。结论加速康复外科下腹腔镜胃D2根治术联合EME治疗进展期胃癌患者可缩短患者住院时间,减少术后并发症发生,减轻机体的细胞免疫反应及炎性反应,术后恢复更快。

Objective To investigate the clinical effect of accelerated rehabilitation surgery(ERAS)laparoscopic D2 radical gastrectomy combined with complete mesangeal gastrectomy(EME)in the treatment of advanced gastric cancer.Methods A total of 138 patients with advanced gastric cancer from March 2018 to March 2020 were selected and divided into ERAS group(n=69)and control group(n=69)according to different perioperative treatments according to random number table method.Laparoscopic D2 radical gastrectomy combined with intact mesangial gastrectomy was performed in both groups.SPSS20.0 software was used for data processing.Measurement data such as intraoperative and postoperative indexes and immune indexes were expressed as (x±s),and independent sample t test was performed.Chi-square test was used to compare postoperative complications between groups,and P<0.05 was considered statistically significant.Results The postoperative exhaust time,activity time out of bed and hospitalization time in ERAS group were significantly lower than those in control group(P<0.05).The total incidence of postoperative complications in ERAS group was 4.3%,significantly lower than in control group(18.8%).The blood CD3^(+),CD4^(+)/CD8^(+)in 2 groups showed a decreasing trend on postoperative day 1,and CD8^(+)showed an increasing trend.The blood CD3^(+),CD8^(+) and CD4^(+)/CD8^(+) in ERAS group were better than those in control group on postoperative day 1,3 and 7(P<0.05).The levels of TNF-α、IL-6、CRP and WBC in ERAS group were significantly lower than those in control group 1,3 and 7 days after operation(P<0.05).Conclusion Laparoscopic D2 radical gastrectomy combined with EME in the treatment of advanced gastric cancer patients with accelerated rehabilitation surgery can shorten the length of hospital stay,reduce postoperative complications,reduce cellular immune response and inflammatory response of the body,and make postoperative recovery faster.