膜解剖技术在胃癌根治术中应用的效果分析

Analysis of the effects of membrane anatomy in radical resection of gastric cancer on reducing complications

目的 探讨膜解剖在胃癌根治术应用的效果。方法 2018年8月~2020年10月我院收治的的胃癌病人146例,根据1∶1随机信封抽签原则将病人分为膜解剖组和对照组,每组各73例。膜解剖组在膜解剖理论指导下行腹腔镜胃癌根治术,对照组行传统血管导向下腹腔镜胃癌根治术,比较两组围手术期相关指标及转期预后。结果 膜解剖组的手术时间、术中出血量、淋巴结清扫个数、术后排气时间、术后下床时间与术后住院时间少于对照组,差异有统计学意义(P<0.05)。膜解剖组术后7天的切口感染、肺部感染、腹腔出血、吻合口漏等并发症发生率为2.7%,低于对照组的21.9%,差异有统计学意义(P<0.05)。膜解剖组术后1天、术后3天、术后7天的疼痛视觉模拟评分法(visual analogue scale, VAS)评分低于对照组,差异有统计学意义(P<0.05)。膜解剖组术后1天、术后3天、术后7天的血清高迁移率族蛋白B1(high mobility group protein B1,hMGB1)含量低于对照组,差异有统计学意义(P<0.05)。随访截止时膜解剖组的复发率、死亡率分别为为16.4%、8.2%,对照组分别为31.5%和20.5%,差异有统计学意义(P<0.05)。结论 胃癌根治术应用膜解剖能有效降低并发症的发生,减少手术创伤,促进病人康复,也能有效缓解疼痛与抑制hMGB-1的释放,降低复发率、死亡率。

Objective To investigate the effect of membrane dissection in radical gastrectomy for gastric cancer.Methods From August 2018 to October 2020,146 cases of patients with gastric cancer who were diagnosed and treated in our hospital were selected as the research objects.All the patients were divided into membrane anatomy group and control group with 73 cases each groups accorded to the 1∶1 random envelope drawing principle.The membrane anatomy group were underwent laparoscopic radical gastric cancer surgery under the guidance of membrane anatomy theory, and the control group were received traditional vascular-guided laparoscopic radical gastric cancer surgery, and were to record and follow-up the prognosis of patients.Results The operation time, intraoperative blood loss, number of lymph nodes dissected, postoperative exhaust time, postoperative time to get out of bed and postoperative hospital stay in the membrane anatomy group were less than those of the control group(P<0.05).The incidence of complications such as incision infection, lung infection, abdominal hemorrhage, and anastomotic leakage in the membrane anatomy group were 2.7%,which were lower than 21.9% in the control group at 7 d after operation(P<0.05).The pain visual analogue scale(VAS) scores of the membrane anatomy group at 1 d, 3 d, and 7 d were lower than those of the control group(P<0.05).The levels of serum high mobility group protein B1(hMGB1) in the membrane anatomy group at 1 d, 3 d and 7 d after operation were lower than those of the control group(P<0.05).All patients were followed up until October 1,2021.The recurrence rate and mortality rate of the membrane anatomy group were 16.4% and 8.2%,which were lower than those of the control group, 31.5% and 20.5%(P<0.05).Conclusion The application of membrane anatomy in radical gastric cancer surgery can effectively reduce the occurrence of complications, reduce surgical trauma, and promote patient recovery.It can also effectively relieve pain and inhibit the release of hMGB-1,thereby reducing the follow-up recurrence rate and mortality of patients.