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

Long-term Clinical Efficacy of Total Laparoscopic Gastrointestinal Anastomosis After Gastric Separation in Elderly Patients with Gastric Cancer Complicated with Pyloric Obstruction

目的 研究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。方法 选取2018年8月-2020年10月我院接诊的72例老年胃癌合并幽门梗阻患者为研究对象,采用随机数字表法分为观察组和对照组,各36例。对照组采用开腹手术治疗,观察组采用全腹腔镜胃部分离断后胃肠吻合术治疗,比较两组临床手术指标、并发症发生率、随访2年生存率和幽门梗阻复发率、应激反应、生存质量。结果 两组手术时间比较,差异无统计学意义(P>0.05),观察组术中出血量、术后下床活动时间、胃管留置时间均小于对照组(P<0.05);观察组并发症发生率为8.33%,低于对照组的19.44%(P<0.05);随访2年,观察组生存率为100.00%,高于对照组的83.33%,幽门梗阻复发率为2.78%,低于对照组的19.44%(P<0.05);两组C反应蛋白(CRP)、白介素-6(IL-6)水平均升高,但观察组低于对照组(P<0.05);两组生存质量水平均高于术前,且观察组高于对照组(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患者可改善患者手术指标、减少应激反应,提高患者生存质量和2年生存率,且可降低并发症发生率,具有较理想的远期疗效。

Objective To study the long-term clinical efficacy of total laparoscopic gastrointestinal anastomosis after gastric separation in elderly patients with gastric cancer complicated with pyloric obstruction. Methods A total of 72 elderly patients with gastric cancer complicated with pyloric obstruction admitted to our hospital from August 2018 to October 2020 were selected as the research objects. They were divided into observation group and control group by random number table method, with 36 cases in each group. The control group was treated with laparotomy,and the observation group was treated with total laparoscopic gastrointestinal anastomosis after gastric separation. The clinical operation indexes,complication rate, 2-year survival rate, recurrence rate of pyloric obstruction, stress response and quality of life were compared between the two groups.Results There was no significant difference in operation time between the two groups(P>0.05). The intraoperative blood loss, postoperative ambulation time and gastric tube indwelling time in the observation group were less than those in the control group( P <0.05). The incidence of complications in the observation group was 8.33%, which was lower than 19.44% in the control group( P <0.05). After 2 years of follow-up, the survival rate of the observation group was 100.00%, which was higher than 83.33% of the control group, and the recurrence rate of pyloric obstruction was 2.78%, which was lower than 19.44% of the control group(P<0.05). The levels of C-reactive protein(CRP) and interleukin-6(IL-6) in the two groups increased, and those in the observation group were lower than those in the control group(P<0.05). The quality of life of the two groups was higher than that before operation, and that of the observation group was higher than that of the control group( P<0.05).Conclusion Total laparoscopic gastric separation after gastrointestinal anastomosis in the treatment of elderly patients with gastric cancer complicated with pyloric obstruction can improve the surgical indicators, reduce stress response, improve the quality of life and 2-year survival rate, and reduce the incidence of complications,with ideal long-term efficacy.