腹腔镜下远端早期胃癌根治术治疗效果及其血清肿瘤标志物的变化

Effect of laparoscopic distal gastrectomy for early gastric cancer and its influence on serum tumor markers

目的分析早期胃癌患者采用腹腔镜下远端胃癌根治术的临床治疗效果及患者血清肿瘤标志物的变化情况。方法前瞻性将2016年1~12月在北京市第二医院治疗的110例早期胃癌患者纳入研究,采用随机数字表法将其分为观察组、对照组,各55例。对照组采用传统开腹手术治疗,观察组采用腹腔镜下远端胃癌根治术治疗。观察比较两组患者治疗的手术相关指标(手术时间、术中出血量、切口长度、住院时长)、术后恢复情况、血清肿瘤标志物[糖类抗原(CA)199、CA125、胃蛋白酶原Ⅰ(PGⅠ)]、炎症因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)、血清肿瘤坏死因子-α(TNF-α)]以及治疗后1、3、5年患者的生存率。结果两组患者的手术时间差异无统计学意义(P>0.05),观察组的术中出血量明显少于对照组,切口长度明显短于对照组,淋巴清扫数目明显多于对照组,差异均有统计学意义(P<0.05)。观察组患者的住院时间,胃肠功能恢复时间、术后开始进食时间明显短于对照组,差异均有统计学意义(P<0.05)。治疗前,两组患者血清肿瘤标志物及炎症因子水平比较,差异无统计学意义(P>0.05),治疗后,观察组CA199、CA125、CRP、IL-6、TNF-α明显低于对照组,PGⅠ明显高于对照组,差异均有统计学意义(P<0.05)。5年随访调查发现,患者在治疗后1年、3年,两组患者的生存率对比差异无统计学意义(P>0.05),治疗后5年观察组的生存率明显高于对照组,差异有统计学意义(P<0.05)。结论早期胃癌患者采用腹腔镜下远端胃癌根治术治疗手术时间与传统开腹术相似,但术中出血量少、切口长度小,住院时间更短,并且可以更为有效地降低血清肿瘤标志物,减轻患者术后炎症反应,患者远期生存率更好。

Objective To analyze the clinical therapeutic effect of laparoscopic radical resection of distal gastric cancer and the changes of serum tumor markers in patients with early gastric cancer.Methods A total of 110 patients with early gastric cancer treated in Beijing Second Hospital from January to December 2016 were prospectively included in the study.The patients were divided into observation group and control group by random number table method,with 55 cases in each group.The control group was treated with traditional open surgery,and the observation group was treated with laparoscopic radical resection of distal gastric cancer.The treatment-related indicators of the two groups of patients(operating time,intraoperative blood loss,incision length,length of stay in hospital),serum tumor markers[carbohydrate antigen(CA)199,CA125,pepsinogenⅠ(PGⅠ)],inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),serum tumor necrosis factor-α(TNF-α)]and the survival rate of patients at 1,3,and 5 years after treatment were observed and compared.Results There was no significant difference in operation time between the two groups(P>0.05).The intraoperative blood loss in the observation group was significantly less than that in the control group,the length of the incision was significantly shorter than that in the control group,and the number of lymphatic dissections was significantly more than that in the control group,the differences were statistically significant(P<0.05).The hospitalization time,gastrointestinal function recovery time,and postoperative eating time of the observation group were significantly shorter than those of the control group,and the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in serum tumor markers and inflammatory factor levels between the two groups(P>0.05).After treatment,CA199,CA125,CRP,IL-6 and TNF-αin the observation group were significantly lower than those in the control group,PGⅠwas significantly higher than the control group,the differences were statistically significant(P<0.05).The 5-year follow-up survey found that there was no significant difference in the survival rate between the two groups at 1 year and 3 years after treatment(P>0.05).The survival rate of the observation group was significantly higher than that of the control group after 5 years of treatment,there was statistical significance(P<0.05).Conclusion Laparoscopic radical gastrectomy for patients with early gastric cancer has similar operation time to traditional laparotomy,but the amount of intraoperative blood loss is less,the incision length is small,the hospital stay is shorter,and the serum tumor markers can be reduced more effectively It can reduce the postoperative inflammation of the patient,and the long-term survival rate of the patient is better.