腹腔镜下胃癌根治术对患者胃肠功能恢复、炎症反应及营养状态的影响

Effect of laparoscopic radical gastrectomy on recovery of gastrointestinal function,inflammatory response,and nutritional status of patients

目的探讨腹腔镜下胃癌根治术对患者胃肠功能恢复、炎症反应及营养状态的影响。方法根据治疗方式的不同将112例胃癌患者分为对照组和研究组,每组56例,对照组患者采用开腹胃癌根治术治疗,研究组患者采用腹腔镜下胃癌根治术治疗。比较两组患者的围手术期指标、胃肠功能恢复指标、炎症反应指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、营养状态指标[血红蛋白(Hb)、视黄醇结合蛋白(RBP)、转铁蛋白(TRF)、前白蛋白(PA)、白蛋白(ALB)]及术后并发症发生情况。结果研究组患者无中转开腹病例。两组患者手术时间、淋巴结清扫数目比较,差异均无统计学意义(P>0.05);研究组患者术中出血量明显少于对照组,首次下床活动时间、住院时间、饮食恢复时间、肠鸣音恢复时间、首次排气时间、首次排便时间均明显短于对照组,差异均有统计学意义(P<0.01)。术后,两组患者TNF-α、CRP、IL-6水平均高于本组术前,研究组患者TNF-α、CRP、IL-6水平均低于对照组,差异均有统计学意义(P<0.05)。术后,两组患者Hb、RBP、TRF、PA、ALB水平均低于本组术前,研究组患者Hb、RBP、TRF、PA、ALB水平均高于对照组,差异均有统计学意义(P<0.05)。研究组患者术后并发症总发生率为5.36%,明显低于对照组患者的23.21%,差异有统计学意义(P<0.01)。结论腹腔镜下胃癌根治术可促进胃癌患者术后胃肠功能恢复,减轻炎症反应,改善营养状态,且安全性较高。

Objective To investigate the effect of laparoscopic radical gastrectomy on recovery of gastrointestinal function,inflammatory response,and nutritional status of patients.Method A total of 112 patients with gastric cancer were divided into control group and study group according to different treatment methods,with 56 cases in each group.The patients in the control group were treated with open radical gastrectomy,and the patients in the study group were treated with laparoscopic radical gastrectomy.The perioperative indicators,gastrointestinal function recovery indicators,inflammatory response indicators[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)],nutritional status indicators[hemoglobin(Hb),retinol-binding protein(RBP),transferrin(TRF),prealbumin(PA),albumin(ALB)]and postoperative complications were compared between the two groups.Result There were no cases of conversion to laparotomy in the study group.There were no significant differences in the operation time and the number of lymph nodes dissected between the two groups(P>0.05).The amount of intraoperative blood loss in the study group was significantly less than that in the control group,and the time to get out of bed for the first time,hospitalization time,diet recovery time,bowel sound recovery time,first exhaust time,and first defecation time were all significantly shorter than those in the control group,the differences were statistically significant(P<0.01).After the operation,the levels of TNF-α,CRP,and IL-6 in the two groups were higher than those before the operation,and the above indexes in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).After the operation,the levels of Hb,RBP,TRF,PA,and ALB in the two groups were lower than those before the operation,and the above indexes in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of postoperative complication in the study group was 5.36%,significantly lower than 23.21%in the control group,and the difference was statistically significant(P<0.01).Conclusion Laparoscopic radical gastrectomy could promote the recovery of gastrointestinal function,reduce inflammation response,improve nutritional status in patients with gastric cancer,and has high safety.