全腹腔镜胃部分离断后胃肠吻合术对老年胃癌合并幽门梗阻的远期临床疗效分析

Analysis of long-term clinical efficacy of gastrointestinal anastomosis after total laparoscopic gastric dissection for elderly gastric cancer with pyloric obstruction

目的:探讨全腹腔镜胃部分离断后胃肠吻合术(TLSPGJ)对老年胃癌合并幽门梗阻的远期疗效。方法:2016年5月至2018年6月,老年胃癌合并幽门梗阻患者150例随机数表法分为观察组(n=75)和对照组(n=75)。对照组行开腹手术治疗,观察组行TLSPGJ治疗。比较两组患者围术期情况,记录治疗前后血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)及生活质量变化,统计术后并发症,随访2年,统计生存率。结果:观察组的出血量低于对照组,首次下床时间、首次进食时间、胃管留置时间、住院时间均短于对照组(P<0.05);治疗后,两组患者的TNF-α、CRP、IL-6含量均升高,观察组低于对照组(P<0.05);治疗后,两组患者的社会功能、生理功能、心理状态、情感职能等评分均降低,观察组低于对照组(P<0.05);观察组并发症发生率6.7%低于对照组17.3%(P<0.05);随访2年,观察组生存率为分别为85.3%、69.3%明显高于对照组的64.0%、52.0%(P<0.05)。结论:全腹腔镜胃部分离断后胃肠吻合术治疗老年胃癌合并幽门梗阻,可减少出血量及应激反应,促进术后恢复,提高患者生活质量及,减少并发症,远期效果显著。

Objective:To investigate the long-term efficacy of total laparoscopic gastrointestinal anastomosis(TLSPGJ)after gastric separation for elderly gastric cancer with pyloric obstruction.Methods:150 elderly patients with gastric cancer and pyloric obstruction admitted from May 2016 to June 2018 were selected as the research objects.Random number table method was used to divide into observation group(n=75)and control group(n=75).The control group underwent laparoscopic gastrojejunostomy,and the observation group underwent TLSPGJ treatment.Compare the perioperative conditions of the two groups of patients,record the changes of serum tumor necrosis factor(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)and quality of life before and after treatment,and count postoperative complications,The patients were followed up for 2 year and the survival rate was counted.Results:The bleeding volume of the observation group was lower than that of the control group,and the time to get out of bed,the time to eat for the first time,the time of gastric tube indwelling,and the length of hospital stay were shorter than that of the control group,and the difference was significant(P<0.05);after treatment,the TNF-The levels ofα,CRP and IL-6 all increased,but the observation group was lower than the control group,the difference was significant(P<0.05);after treatment,the scores of social function,physiological function,mental state,emotional function of the two groups of patients decreased,And the observation group was lower than the control group,the difference was significant(P<0.05);the complication rate of the observation group was 6.67%lower than the control group 17.33%,the difference was significant(P<0.05);after 2 years of follow-up,the survival rates of the observation group were 85.33%and 69.33%,respectively,which were significantly higher than those of the control group,which were 64.00%and 52.00%,respectively(P<0.05).Conclusion:Gastrointestinal anastomosis after laparoscopic gastrectomy for gastric separation in elderly patients with gastric cancer complicated with pyloric obstruction can reduce the amount of bleeding and stress response,promote postoperative recovery,improve the patient's quality of life and survival rate,reduce complications,and have a significant long-term effect.It is recommended for clinical promotion.