不同手术方式对早期胃癌患者围术期相关指标及预后生存的影响

Effects of different surgical methods on perioperative indicators, prognosis and survival of patients with early gastric cancer

目的 探讨不同手术方式对早期胃癌患者围术期相关指标及预后生存的影响。方法 以2016年4月~2017年4月本院收治的100例早期胃癌患者为研究对象。对照组35例接受开腹胃癌根治术,观察组65例患者接受腹腔镜下胃癌根治术。比较两组围术期相关指标(手术时间、术中出血量、胃肠蠕动恢复时间、术后进食时间、住院时间)、术后并发症发生率、预后生存情况。比较两组术前、术后外周血白细胞(WBC)计数、C反应蛋白(CRP)、白介素-6(IL-6)、白介素-10(IL-10)、皮质醇(COR)、免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、补体3(C3)、补体4(C4)含量。结果 观察组术中出血量明显少于对照组,胃肠蠕动恢复时间、术后进食时间明显早于对照组,住院时间明显短于对照组,差异均有统计学意义(P<0.05)。术后观察组外周血CRP、WBC、IL-6、COR水平明显低于对照组,IL-10、C3水平明显高于对照组,差异均有统计学意义(P<0.05)。两组术后2年生存率无统计学差异(P=0.810)。结论 腹腔镜下胃癌根治术术后恢复快、对机体应激状态与免疫功能的影响较小,可在临床推广。

Objective To investigate the effects of different surgical methods on perioperative indicators, prognosis and survival of patients with early gastric cancer.Methods A total of 100 patients with early gastric cancer treated in our hospital from April 2016 to April 2017 were selected as the subjects of this study. Among them, 35 patients underwent radical gastrectomy and were set as control group. 65 patients underwent laparoscopic radical gastrectomy for gastric cancer and were divided into observation group. Patients in the control group received open radical gastrectomy, and patients in the observation group received laparoscopic radical gastrectomy. Perioperative related indicators(operative time, intraoperative blood loss, gastrointestinal peristalsis recovery time, postoperative feeding time, length of hospital stay), incidence of postoperative complications, prognosis and survival were compared between the two groups. WBC count, C-reactive protein(CRP), interleukin-6(IL-6), interleukin-10(IL-10), cortisol(COR), immunoglobulin G(IgG), immunoglobulin A(IgA), immunoglobulin M(IgM), complement 3(C3) and complement 4(C4) contents in serum of the two groups were compared before and after operation. Results The amount of intraoperative blood loss in the observation group was significantly lower than that in the control group.The recovery time of gastrointestinal peristalsis and postoperative feeding time were significantly earlier than those in the control group.The length of hospitalization was significantly shorter than that of control group(P<0.05).After operation, the levels of CRP, WBC, IL-6 and COR in peripheral blood in the observation group were significantly lower than those in the control group, while the levels of IL-10 and C3 were significantly higher than those in the control group(P<0.05).There was no significant difference in the 2-year postoperative survival rate between the observation group and the control group(P = 0.810).Conclusion Laparoscopic radical gastrectomy for gastric cancer has the advantage of quick postoperative recovery and little influence on stress state and immune function of the body.